306006095-7-14-2023-22-AS-SSAS-CU43A4-20230725180407

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006095
Report Date: 07/14/2023
Date Signed: 07/14/2023 04:38:35 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230217143103

FACILITY NAME:	EPIC ASSISTANCE CARE HOME		FACILITY NUMBER:	306006095
ADMINISTRATOR:	MESDJIAN, LIZA		FACILITY TYPE:	740
ADDRESS:	26751 CARRETAS DRIVE		TELEPHONE:	(818) 220-0282
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 1	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Liza Mesdjian, Administrator (via telephone)		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Questionable Death.
Staff gave resident alcohol without resident's representative's permission.
Staff did not address resident's change in condition.
Staff did not notify resident's representative about their change in condition.
Staff do not treat resident in care with dignity.
Staff do not provide adequate supervision to residents in care.

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced inspection visit to deliver findings in the investigation of the allegations stated above. LPA was greeted and granted entry by caregiving staff after explaining the purpose of the visit. Licensee Liza Mesdjian was notified by telephone and read the report via telephone as well. LPA detailed the nine allegations that were under investigation.

An initial complaint investigation visit was conducted on February 22, 2023. During the visit, LPA accompanied by caregiving staff conducted a tour of the physical plant including the kitchen, dining area, living room, private bedrooms, and shared bathrooms for the five residents in care at the facility. A follow-up investigation visit was led on April 19, 2023.

CONTINUED ON FORM LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2023 and conducted by Evaluator Kevin Saborit-Guasch

COMPLAINT CONTROL NUMBER: 22-AS-20230217143103

FACILITY NAME:	EPIC ASSISTANCE CARE HOME		FACILITY NUMBER:	306006095
ADMINISTRATOR:	MESDJIAN, LIZA		FACILITY TYPE:	740
ADDRESS:	26751 CARRETAS DRIVE		TELEPHONE:	(818) 220-0282
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 1	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Liza Mesdjian, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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9

Resident was not accorded privacy during visitations.

Staff do not provide activities for residents in care.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
	VISIT DATE: 07/14/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Resident was not accorded privacy during visitations, the following has been concluded: Based on interviews conducted with staff members, residents and multiple witnesses, no instance or reported interference with privacy during visitations was reported. It was initially alleged that resident R2 had been observed to be inebriated and interrupting visits to other residents on the back patio of the facility. Based on observation, interviews and records reviewed, the behavior described in the initial complaint is consistent with signs of the dementia diagnosis of resident R2 rather than to the influence of intoxicants. Witness 2 (W2) confirmed that he has always been accorded adequate privacy during his visits to his relative. Witness 3 (W3) stated that he felt he was always being provided with sufficient privacy during visits. The allegation is therefore deemed to be Unsubstantiated, meaning that 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.

Regarding the allegation that Staff do not provide activities for residents in care, the following has been concluded: Witness 4 (W4), responsible party for resident 4 (R4) confirmed that the activities provided were in accordance with their relatives’ preferences and wishes which were also verified to be documented in R4’s assessment. W5 additionally confirmed that activities offered corresponded to their relative’s expressed wishes and preferences, which was also corroborated by LPA’s observation during the initial complaint investigation and follow-up facility visit. As a result, the allegation is deemed to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
	VISIT DATE: 07/14/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099 The allegations listed above have been filed regarding resident (R1). R1 was 96 year old at the time of her passing and a resident of Epic Assistance Care Home for the previous 3 years. Per her latest Physician’s Report dated February 6, 2022, resident was experiencing confusion, forgetfulness, signs of sundowning and depression. Resident was also noted to be unable to verbalize their needs, had bladder impairment with a Foley catheter in place and incontinence of bowel. Resident stated to require mild to moderate assistance with self-care and transfers. There was no use of alcohol. Medical diagnoses documented included Acute on Chronic diastolic Congestive Heart Failure (CHF), Pulmonary edema and Dementia.

LPA requested, obtained, and reviewed the resident records for the five residents at the time of the visit. Medical records to Mission Hospital in Mission Viejo were received at the Regional Office for review on March 20, 2023. LPA reviewed the records. LPA Kevin Saborit-Guasch conducted additional witness interviews with relatives of the facility’s residents along with responsible parties on file. R1’s death certificate number 3052022265306 dated November 21, 2022, confirmed R1 passed away on November 9, 2022, with immediate cause of death of Acute Cardiopulmonary arrest and the underlying cause of vascular dementia.

Records provided include the resident's face sheet, visit report for an Emergency Department visit dated November 9, 2022, stating a Chief Complaint of Altered Mental Status, with an oxygen saturation measured at 78% in the field and Emergency Medical Services personnel performing mechanical ventilation. Diagnoses include a Glasgow score of 3-8, hypotension, Acute renal failure, Dementia and a Urinary Tract Infection. Resident is noted to be undergoing septic shock alongside Acute renal failure and congestive heart failure. Resident infection status makes mention of a Methicillin-resistant Staphylococcus aureus added to the resident's file on May 15, 2021 and marked as resolved after the resident passed away on November 9, 2022. Resident also had an indwelling Foley catheter.

The Mission Hospital admission notes indicate: “96-year-old female with a history of dementia, UTI, anemia with altered mental status. Patient was visiting with their son when they became unresponsive. Patient was hypotensive in the field. Patient brought in with a blood pressure of 49/25. On arrival I discussed code status and wishes with the daughter and son who indicate patient is DNR, no chest compressions and no intubation. He states they have treated with antibiotics and IV fluids in the past. On arrival patient is unresponsive, nonverbal, not following commands, has no doll's eyes and agonal respirations. Patient is not moving their extremities purposefully.” CONTINUED ON FORM LIC9099-C

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
	VISIT DATE: 07/14/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099-C
Regarding the allegation of Questionable Death, the following has been concluded: Based on review of medical records provided by Mission Hospital for the period of July 15, 2022 until November 9, 2022, death certificate and interviews conducted, the resident’s death was deemed to have been caused by natural causes, with immediate cause of death of Acute Cardiopulmonary arrest and the underlying cause of vascular dementia. Comprehensive Metabolic Panel done upon admission into the Emergency Department shows abnormal K, CO2, BUN, Creatinine, Albumin, Protein, Alkaline Phosphatase and eGFR levels, which are overall signs of kidney injury/disease consistent with the UTI diagnosis. There were no results of any lab work on ethanol done to reflect any alcohol consumption. An additional review of potential medications that could decrease alertness of resident-based resident’s latest Medication Administration Records dated November 2022 as well as the list of medications in hospital records upon admission on November 9, 2022 was completed. The listed side effects are mild to moderate. All the medications listed and reviewed can cause cognition impairment in addition to the documented dementia diagnosis. No indication of a regular consumption of alcohol having caused or contributed to the resident’s condition could be inferred by the evidence gathered. As a result, the allegation is deemed to be Unfounded meaning that meaning the allegation is false, could not have happened and/or is without a reasonable basis.

Regarding the allegation that Staff gave resident alcohol without resident's representative's permission, the following has been concluded: Per statement of witness 1 (W1), resident R2 is medically cleared to consume one 2-ounce glass of wine alongside the dinner meal daily. The wine in question is being provided by the resident’s son and daughter and not purchased directly by the facility. The quantity stated to be provided is not consistent with the wine being served in greater amounts or to a higher number of residents. W1 stated "It's something that I bring from my business. We're not sharing it with anybody." LPA was able to observe dinner being served during the initial complaint investigation visit and was able to confirm the statements made during the interviews. Per statement of witness 2, it was confirmed that the responsible party for resident R1 had initially given staff permission to occasionally serve alcohol to resident R1 on festive occasions and later withdrew permission due to R1’s observed health condition. None of the evidence gathered corroborates the allegation. As a result, the allegation is deemed to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

CONTINUED ON FORM LIC9099-C

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
	VISIT DATE: 07/14/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099-C

Regarding the allegation that Staff did not address resident's change in condition, the following has been concluded: When R1’s condition worsened on or around November 7, 2022, the responsible party and primary care physician were notified right away. R1 had been diagnosed with anemia and prescribed with supplemental oxygen by their primary care provider in October 2022. After notifying the interested parties, facility staff scheduled a doctor’s visit on November 8, 2022. When R1 was found unresponsive on November 9, 2022, in presence of their daughter, paramedics were activated timely and transferred the resident to Mission Hospital where they were admitted to comfort care shortly before passing away. No delay or lack of response by facility staff could be evidenced from interviews conducted and records reviewed. The allegation is therefore deemed to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Regarding the allegation that Staff did not notify resident's representative about their change in condition, the following has been concluded: Witness 2 (W2), indicated in the records reviewed as the responsible party and durable power of attorney for resident R1, states that overall they were notified whenever anything important needed to be reported. W2 states that on November 7, 2022, they received an early morning call from a facility caregiver that their mother was not doing very well. Doctor was called the next day and the R1 was put on oxygen. W2 states that overall he feels that the caregivers kept on top of communications with the responsible parties. W2 goes back to a fall incident with no injury that occurred in 2020 for which they were called right away. Those calls along with conversations held during the families' visits felt adequate to W2, who stated "I do not have a sense that they were withholding information". Witness 3 (W3) corroborated by stating that their relative was taken to the hospital a few times and facility staff always made sure to notify [the responsible party], regardless of the hour at which the transfer occurred. W2 states that they typically hear from facility staff before R1’s physician whenever an appointment is made or updates to R1’s treatment are made. The allegation is therefore deemed to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

CONTINUED ON FORM LIC9099-C

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 9 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/17/2023 and conducted by Evaluator Kevin Saborit-Guasch

COMPLAINT CONTROL NUMBER: 22-AS-20230217143103

FACILITY NAME:	EPIC ASSISTANCE CARE HOME		FACILITY NUMBER:	306006095
ADMINISTRATOR:	MESDJIAN, LIZA		FACILITY TYPE:	740
ADDRESS:	26751 CARRETAS DRIVE		TELEPHONE:	(818) 220-0282
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS:	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Liza Mesdjian, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not follow proper Covid-19 safety protocols.

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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

LIC9099 (FAS) - (06/04)

Page: 6 of 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
	VISIT DATE: 07/14/2023

NARRATIVE

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CONTINUED FROM LIC9099-A

Regarding the allegation that Staff did not follow proper Covid-19 safety protocols, the following has been concluded: Based on interviews conducted, approximately in October or November 2022, multiple staff members tested positive for COVID-19 and were kept on active duty providing care and supervision for residents with both positive- and negative-testing status. Administrator is stated to have justified her decision with the difficulty recruiting relief staff on short notice.

However, the facility neither reported the positive cases within the facility, nor did they report being in a Critical Staffing Shortage as required by the updated Provider Information Notice PIN 22-09-ASC on Updated Guidance on Quarantine and Isolation for Facility Staff Exposed to COVID-19 and Return to Work for Facility Staff who Test Positive for Coronavirus Disease-19 (COVID-19) in order to bypass the Isolation guidelines applicable in Routine Staffing situations. W4 stated that approximately at the end of November 2022, they contracted COVID along with their family member placed at the facility and the two caregivers. Both caregivers are stated to have had to care for all of the residents which was justified to W4 by the facility owner as needed due to the difficulty or impossibility to gather additional staff. W4 states it was "not a good situation" and adds that at one point they received a call from resident (R4) hospice nurse who was worried R4 would pass away during the night.

As a result, the allegation is deemed to be Substantiated, meaning that during the course of the investigation, the preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 Chapter 8 of the California Code of Regulations.

An exit interview was conducted and a copy of this report along with appeal rights were provided to facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

Page: 7 of 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/28/2023 Section Cited CCR 87470(b)(3)	1 2 3 4 5 6 7	The California Code of Regulations Section 87470(b)(3) on Infection Control Requirements states that: “There shall be separation and care of residents whose illness requires separation, including quarantine or isolation, from others.”	1 2 3 4 5 6 7	Licensee to update the Infection Control Plan and provide staff members with training on the recommendations in place to avoid the transmission of respiratory infections.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Interviews and licensee admission that staff members with confirmed COVID-19 diagnosis kept on providing care and supervision without the facility having reported a Critical Staffing Shortage.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023

LIC9099 (FAS) - (06/04)

Page: 8 of 10

Control Number 22-AS-20230217143103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: EPIC ASSISTANCE CARE HOME	FACILITY NUMBER: 306006095
	VISIT DATE: 07/14/2023

NARRATIVE

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CONTINUED FROM LIC9099-C

Regarding the allegation that Staff do not treat resident in care with dignity, the following has been concluded: Witness 4 (W4) stated that "I feel like both [caregivers] work hard to provide a nice clean environment. I looked at a lot of facilities before deciding to admit my family member there.” W3 stated "They're really good there, they're really nice people and more importantly my family member is happy there". W1 stated that they are at the facility three days a week along with other family member being there the other four days, and that they are in and out at different hours every time and never witnessed anything of concern. No residents or witnesses interviewed had any instance of disrespectful or inappropriate behavior by any caregiver to report, even as they were specifically asked if they did. As a result, the allegation is deemed to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Regarding the allegation that Staff do not provide adequate supervision to residents in care, the following has been concluded: Based on a review of records conducted at the facility along with multiple interviews with witnesses including R1’s responsible party, care and supervision provided by staff members was described as being very caring. W 1 indicated that their family are very satisfied with the staff and the level of care and attention provided by the caregivers to the residents. W1 states that one of their in-laws had resided at the facility prior to their passing and that this is what brought them to admit their own family member there when their needs made it necessary. W2 stated similarly that "It's not perfect, of course, but for me and most of the family members, it was far above the level of adequate. Most of us were comfortable to very comfortable with the regular care and activities provided at the facility." The allegation is therefore deemed to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 10 of 10