197609969-6-30-2025-29-AS-KHEN-DJ674W-20250630212033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609969
Report Date: 06/30/2025
Date Signed: 06/30/2025 07:00:42 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2024 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240516080757

FACILITY NAME:	VALLEY VISTA SENIOR LIVING		FACILITY NUMBER:	197609969
ADMINISTRATOR:	ELIZABETH J WHITTINGTON		FACILITY TYPE:	740
ADDRESS:	7040 VAN NUYS BLVD		TELEPHONE:	(818) 906-4400
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	164	CENSUS: 77	DATE:	06/30/2025
		UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Elizabeth Whittington, Executive Director		TIME COMPLETED:	07:10 PM

ALLEGATION(S):

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1. Facility did not provide resident with a bed/dresser
2. Facility did not provide resident with hygiene products

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted another subsequent unannounced complaint visit to continue the investigation for the above allegations and to deliver the findings of the investigation. LPA met with Elizabeth Whittington, Executive Director. The reason for today's visit was provided.

On the initial visit conducted on 5/22/24, LPA Yee conducted an interview with Maria Calderon at 11:41am, Jarred Massey-Baker, Memory Care Director at 12:07pm, Staff #1 at 1:23pm, Staff #2 at 1:50pm, telephone interview with Witness #1 at 2:04pm and the Administrator at 2:56pm. Resident #1's file was reviewed at 2:28pm and copies requested. Based on the information received during the initial visit, further investigation was needed to make a finding for the above allegations. Exit interview was conducted.

A subsequent unannounced complaint visit was conducted on 6/19/25 to continue the investigation of the above allegations and LPA met with Elizabeth Whittington, Executive Director. On the subsequent visit

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

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 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 06/30/2025

NARRATIVE

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LPA Yee reviewed and collected additional documents related to the investigation throughout the visit and conducted additional interviews with the Executive Director at 1:31pm, attempted to conduct telephone interviews with Staff #3 and Staff #4. Staff #3 returned LPA Yee's call at 3:51pm and began the telephone interview and the call was disconnected at 4:03pm. When LPA Yee called back at 4:04pm, she was informed by Staff #3 that the phone interview was being conducted on personal time and to conduct the interview during working hours. Staff #4 was contacted at 4:07pm and LPA Yee left a voice mail message to return the call. No return call was received when the subsequent visit was concluded. Hygiene products and toilet paper were observed in a large closet located on the second floor at 5:45pm. Additional hygiene products are also stored in a smaller closet on the third floor and toilet paper is located in the housekeeping closets on each floor. Based on the information received on today's visit and the need to conduct interviews with Staff #3 and Staff #4, it was determined that further investigation is needed before a determination could be made for the above allegations. An exit interview was conducted and a copy of this report was provided.

On today’s visit LPA Yee conducted an interview with Staff #5 at 10:49am, Staff #6 at 11:34am and another telephone interview with Witness #1 at 11:23am to obtain additional information regarding facility furniture and hygiene products.

Per the investigation conducted, the following was revealed regarding allegation #1-facility did not provide resident with a bed/dresser, the staff are confused about who provides the furniture for the residents’ use. Staff all indicated that the residents bring in their own furniture. Per interview conducted with Maria Calderon, Wellness Director at the time of Resident #1’s admission, she stated that the family of the resident provides the furniture for the residents’ use. Per interview conducted with Witness #1, they were told to purchase a bed and a dresser by Elizabeth Whittington, Sales Manager *****who was making the arrangements for Resident #1’s move in on 9/22/23. Per Witness #1, Elizabeth Whittington, told them that the facility does not provide a bed, a dresser, a phone and hygiene products. She provided the family with a link to Apria, where the facility buys their health supplies. Per Witness #1, they didn’t know that the furniture had to be delivered first before Resident #1 could move in. Per Witness #1, Resident #1 was taken back to the Emergency Room until the furniture could be delivered. Resident #1 did not move in until 9/29/23. Also, per review of the signed Admission Agreement - #5 j) “Furnishing” under “Accommodations and Basic

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 06/30/2025

NARRATIVE

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Services” the facility states that “If the resident is unable to provide Resident’s own furniture or if the resident chooses not to provide it, the Community will ensure that the resident is provided with the basic furniture.” This did not happen. The facility did not provide Resident #1 with a bed and dresser as stated in the Admission Agreement and delayed the resident’s move-in date to 9/29/23. Per the initial interview conducted with Executive Director on 5/22/24, LPA Yee was specifically told that they had beds and lamps that the family can rent or loan. In the subsequent interview conducted on 6/19/25, the Executive Director denies that she told the family that they had to buy a bed and a dresser. Based on the interviews conducted with staff, there is confusion as to who provides the required Title 22 furniture. Staff all indicated that the resident's families provide the required furniture. Per the information received during the investigation, there is sufficient evidence to support the allegation that the facility did not provide resident with a bed and a dresser, therefore the allegation is deemed substantiated at this time.

The investigation into allegation #2 - Facility did not provide resident with hygiene products, revealed that the facility does not provide hygiene products to the residents on an ongoing basis. Per interviews conducted with staff, Residents’ families are required to bring in hygiene products such as body soap, shampoo, lotions, toothbrushes and toothpaste for the residents’ use. When the hygiene products run low, the manager contacts the family to replenish the hygiene products. Per staff, the facility will provide temporary hygiene products for residents’ use if they have extras or until the family is able to bring the hygiene products. Per review of the Admission Agreement under #2 “Fees” letter e) Personal Supplies: The Community assumes that the resident will provide their own supplies for personal care and hygiene. The Admission Agreement does not make provisions to ensure that residents who are unable or choose not to provide their own hygiene products, with hygiene items of general use such as soap and toilet paper. Based on the information obtained during the investigation, there is sufficient evidence to support the allegation that the facility does not provide residents with hygiene products, therefore the allegation is deemed substantiated at this time.

Deficiencies are cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

Exit interview was conducted, Appeals Rights were discussed and a copy was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 9

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/16/2024 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20240516080757

FACILITY NAME:	VALLEY VISTA SENIOR LIVING		FACILITY NUMBER:	197609969
ADMINISTRATOR:	ELIZABETH J WHITTINGTON		FACILITY TYPE:	740
ADDRESS:	7040 VAN NUYS BLVD		TELEPHONE:	(818) 906-4400
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91405
CAPACITY:	164	CENSUS: 77	DATE:	06/30/2025
		UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Elizabeth Whittington, Executive Director		TIME COMPLETED:	07:10 PM

ALLEGATION(S):

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3. Staff stole residents necklace
4. Staff stole residents perfume
5. Staff did not clean residents room
6. Due to lack of supervision, resident had multiple falls resulting in injury
7. Staff did not wash residents hair properly

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 06/30/2025

NARRATIVE

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LPA Yee reviewed and collected additional documents related to the investigation throughout the visit and conducted additional interviews with the Executive Director at 1:31pm, attempted to conduct telephone interviews with Staff #3 and Staff #4. Staff #3 returned LPA Yee's call at 3:51pm and began the telephone interview and the call was disconnected at 4:03pm. When LPA Yee called back at 4:04pm, she was informed by Staff #3 that the phone interview was being conducted on personal time and to conduct the interview during working hours. Staff #4 was contacted at 4:07pm and LPA Yee left a voice mail message to return the call. No return call was received when the subsequent visit was concluded. Hygiene products and toilet paper were observed in a large closet located on the second floor at 5:45pm. Additional hygiene products are also stored in a smaller closet on the third floor and toilet paper is located in the housekeeping closets on each floor. Based on the information received on today's visit and the need to conduct interviews with Staff #3 and Staff #4, it was determined that further investigation is needed before a determination could be made for the above allegations. An exit interview was conducted and a copy of this report was provided.

On today’s visit LPA Yee conducted an interview with Staff #5 at 10:49am, Staff #6 at 11:34am and another telephone interview with Witness #1 at 11:23am to obtain additional information regarding facility furniture and hygiene products.

The investigation regarding Allegation #3 – staff stole the resident’s necklace, interviews and file review, reveal that Resident #1 and the facility did not complete an LIC621 “Client/Resident Personal Property and Valuables.” Per interviews conducted, no one observed Resident #1 with a gold chain and a gold cross. There is also no documentation that Resident #1 owned a gold chain with a gold cross and that it was brought into the facility. Staff who were interviewed stated that they observed Resident #1 with a rope chain that was tarnished with a cross that had rhinestones. Resident #1 was wearing it when they moved from the facility. Another Staff stated that they saw the resident wearing a thick chunky silver chain that was tarnished and does not remember if it had a cross or any pendant. Resident #1 also wore a bracelet. Resident #1 would take off the necklace and then put it back on. Per Staff interviewed, the jewelry were not of any value that someone would want to steal it or mind if it got lost. Per Staff #4, they had a great rapport

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 06/30/2025

NARRATIVE

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Page 3A

with the family and spoke daily and yet the family never mentioned anything about the missing chain. Per the Memory Care Director, they looked for the necklace when the family brought up the missing necklace and was not able to locate the necklace matching the During the investigation, LPA was not able to locate anyone who observed Resident #1 wearing a gold chain with a gold cross or anyone to establish the existence of the gold necklace. Unless new information surfaces, there is insufficient evidence at this time to support the allegation that the staff stole the residents necklace, therefore, the allegation is unsubstantiated at this time.

Per LPA Yee's investigation in regards to Allegation #4 - staff stole residents perfume, the investigation revealed that staff observed that Resident #1 had many perfumes and loved perfumes. The mini bottles of perfumes were stored in a glass vanity drawer. The resident would take all the perfumes out of the drawer just to decide which perfume was going to be used and then put them all back. If the resident had anything of value, the perfumes would be it. Per interview with staff, the number of perfumes owned by Resident #1 varied. One staff indicated that the resident owned 7-8 mini bottles of perfume, one staff indicated that the resident had 2-3 medium bottles of perfume and another just indicated the resident had many but never saw anyone using them. Per staff, the perfumes were packed up when resident #1 relocated to another home on 1/15/24. Staff are surprised that the family are now bringing up all these missing items months later. Per staff, they don't know what happened to the perfumes. The family never said anything when Resident #1 lived here. Based on the investigation, LPA Yee was not able find sufficient evidence to support the allegation that staff stole the residents perfumes, therefore the allegation is unsubstantiated at this time.

The investigation into Allegation #5 - Staff did not clean residents room, the resident's family alleges that they dropped a plant on the floor and the dirt fell out. Staff left the dirt on the floor for weeks and staff did not clean it up. Per interview conducted with Staff #1, who is assigned to the Memory Care Unit, Resident #1 had a tiny plant on the window. Resident #1 loved to throw the plant. They would pick up the dirt and put it back in the pot. Resident #1 threw the plant because resident would get anxious when family member left. Per Staff #1, Resident #1's room is cleaned every Wednesday and the common areas are cleaned everyday. There is no dirt left on the floor. Staff #1 works from Tuesday - Saturday and if the floor is dirty, staff will tell her. On the days Staff #1 is off and there is an emergency another staff will clean up. The floor is never left dirty. Other staff interviewed also confirm that the floor is never left dirty for days. Managers do room checks and staff will hear about it. Per the investigation, there is insufficient evidence to support the allegation that

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 6 of 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 06/30/2025

NARRATIVE

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staff did not clean the resident's room, therefore the allegation is deemed unsubstantiated at this time.

Per information received during the investigation for Allegation #6 - Due to lack of supervision, resident had multiple falls resulting in injury, the investigation revealed that Resident #1, who is diagnosed with dementia and is placed in the Memory Care located on third floor. The third floor is fire cleared for delayed egress. She uses a walker to assist in ambulating. Per review of the staff schedule, the staff in Memory Care consists of a Medication Technician and 2 caregivers for the morning and evening shift and a Medication Technician and a caregiver in Memory Care and one in Assisted Living on the NOC shift. Per information, provided, Resident #1 is able to move around freely in their room and in the the common areas. Per interviews with staff, Resident #1 is very aggressive with their walker and is told to slow down or to be careful in the use of the walker. The staff do not restrict Resident #1's movement and do not follow the resident around and falls are expected since the facility does not provide one on one supervision to catch the resident each time they fall. Per review of hospital discharge documents obtained, Resident #1 has had 3 un-witnessed falls and one witnessed fall in the dining room. The resident had their first fall on 10/16/23 in the dining room. Resident did not sustain any injury and was not sent to the hospital at the request of family. The second fall was sustained on 12/10/23 and 911 was called and the resident was transported to the hospital to be assessed. CT scans were done on the head and cervical spine. There were no signs of fracture. Resident sustained a scalp hematoma that was treated and was discharged. The third fall was sustained on 12/17/23. A CT scan was done on the facial bones and no fracture was observed. A fourth fall was sustained on 1/1/24. CT scans were done on the cervical spine and brain, chest x-rays and right elbow x-rays were done. CT scans and x-rays were ordered and came back okay related to the fall. Resident had a frontal scalp swelling. The resident was placed on 24 hour monitoring upon return. Per the investigation, the falls are not due to lack of supervision, the resident has the right to move around and do activities without interference from staff. Staff are present to ensure the resident's safety and to obtain medical attention when the resident falls. Based on the investigation, there is insufficient evidence to support the allegation that due to lack of supervision, resident had multiple falls, resulting in injury, therefore the allegation is unsubstantiated at this time.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 7 of 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
	VISIT DATE: 06/30/2025

NARRATIVE

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Per investigation into Allegation #7 - Staff did not wash residents hair properly, the investigation revealed that Resident #1's hair is washed when they are showered. The resident is showered 2 times a week. Per information received from interviews, when the resident first moved in, they would not let the caregivers give them a shower, wash and comb their hair. The resident's hair would be matted because they were taking care of their own hair. Per the caregivers interviewed, once Resident #1 finally got comfortable with them, they would allow them to wash the resident's hair and add conditioner to take out the tangles. They would comb Resident #1's hair and put it in a pony tail everyday. Resident #1's hair was never in a dreadlock as alleged by family. Resident #1 is a very clean person and would bring a comb or brush to find Staff #3 or Staff #4 to comb their hair. Per Staff #3 and Staff #4, they also have African American hair and they know how to care for Resident #1's hair. They also put lotion on Resident #1 after a shower or if they observed their skin to be dry. Per staff, Resident #1 always smelled of lotion. Per interview with family, the facility has an outside hair contractor who refused to do hair grooming for Resident #1 because they were unfamiliar with African American hair. Based on the investigation, there is insufficient evidence to support the allegation that the staff did not wash residents hair properly, therefore the allegation is unsubstantiated at this time.

Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8

Exit interview was conducted, Appeals Rights were discussed and a copy was given.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 8 of 9

Control Number 29-AS-20240516080757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VISTA SENIOR LIVING	FACILITY NUMBER: 197609969
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/30/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/07/2025 Section Cited CCR 87307(a)(3)(A-B)	1 2 3 4 5 6 7	Personal Accommodations and Services:The following provisions shall apply-Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. A bed for each resident, except that married couples may	1 2 3 4 5 6 7	The Licensee will ensure that a resident is provided with a bed, chair, lamp, night stand and a closet if they are unable or choose not to provide them. Licensee will review Title 22 Section 87307 - Personal Accommodations and Services and submit a written statement that the section was read, understood and will be
	8 9 10 11 12 13 14	be provided with one appropriate sized bed. B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. A bed and a dresser was not provided for Resident #1's use	8 9 10 11 12 13 14	adhered to at all times by 7/7/25.
Type B 07/07/2025 Section Cited CCR 87307(a)(3)(D)	1 2 3 4 5 6 7	Personal Accommodations and Services:The following provisions shall apply-Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident....if the resident is unable or chooses not to provide them,	1 2 3 4 5 6 7	The licensee will review and update the Admission Agreement to include provisions of personal hygiene supplies if the resident is unable to or chooses not to provide personal hygiene supplies and how the facility will make available hygiene items available for the residents' residents.
	8 9 10 11 12 13 14	the licensee shall assure provision of D) Hygiene items of general use such as soap and toilet paper.	8 9 10 11 12 13 14	use. Licensee will also educate the staff so that they are aware that hygiene products wll be provided by the facility if the resident chooses not to provide them. Provide a copy of the revised Admission Agreement related to Personal Hygiene by 7/7/25

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

Page: 9 of 9