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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900100
Report Date: 06/24/2025
Date Signed: 06/24/2025 03:47:26 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2022 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220909164619
FACILITY NAME:BRASWELLS YUCAIPA LEISURE MANORFACILITY NUMBER:
360900100
ADMINISTRATOR:LINDA WOOFTERFACILITY TYPE:
740
ADDRESS:32195 AVENUE ETELEPHONE:
(909) 797-1314
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:61CENSUS: 51DATE:
06/24/2025
UNANNOUNCEDTIME BEGAN:
01:15 AM
MET WITH:Linda WoofterTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Resident sustained rashes while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver complaint investigation findings. After introducing herself, LPA met Administrator, Linda Woofter, to discuss the findings.

On September 09, 2022, the Department received a complaint on the above allegation pertaining to resident #1 (R1). The Department’s investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals.

Regarding the allegation, resident sustained rashes while in care, it was alleged that on 8/14/2022 R1 was observed with rashes on their body. On 8/14/2022, R1 was medically assessed with end stage dementia, L1 compression fracture,
L intertrochanteric hip fracture, and skin tears of bilateral elbows. On the same day, an integumentary/skin assessment was also conducted and R1 was found to have no lesions, irritations, or redness.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
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 10
Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
VISIT DATE: 06/24/2025
NARRATIVE
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Due to conflicting information received, it could not be determined that facility staff neglected R1 resulting in R1 sustaining rashes while in care, therefore, the allegation is Unsubstantiated.

An Unsubstantiated finding means 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.

An exit interview was conducted where reports (LIC 9099 & LIC9099-C) were discussed, and a copy was provided to Administrator Woofter at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2022 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220909164619

FACILITY NAME:BRASWELLS YUCAIPA LEISURE MANORFACILITY NUMBER:
360900100
ADMINISTRATOR:LINDA WOOFTERFACILITY TYPE:
740
ADDRESS:32195 AVENUE ETELEPHONE:
(909) 797-1314
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:61CENSUS: 51DATE:
06/24/2025
UNANNOUNCEDTIME BEGAN:
01:15 AM
MET WITH:Linda WoofterTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Facility staff did not seek medical attention in a timely manner for resident
Neglect/lack of care and supervision resulting in resident sustaining multiple injuries
Neglect/lack of care and supervision resulting in resident sustaining skin tears
Facility staff did not inform authorized representative of resident's injuries.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to deliver complaint investigation findings. After introducing self, LPA met Administrator, Linda Woofter, to discuss the findings.

On September 9, 2022, the Department received a complaint on the above allegations. The Department investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals.

Regarding the allegation, facility staff did not seek medical attention in a timely manner for resident, investigation revealed that on 8/13/2022, facility staff left resident #1 (R1) unattended in the dining room and R1 had an unwitnessed fall. Staff returned to the dining room and found R1 on the tile floor near the door. R1 had been left sitting at the dining table. Staff assessed R1 and transported R1 back to R1's bedroom and put R1 in bed. At the time of the fall (incident), it was found that R1 had been left unattended. It was not known how long R1 had been on the floor. Emergency services were not contacted for R1 on the day of the fall. Neither R1’s responsible party nor physician were immediately notified by the facility after the unwitnessed fall. In addition, facility staff revealed that night shift was not informed that R1 had an unwitnessed fall during the day. It is not known what happened during the night shift, between 11 pm to 7 am regarding R1 observation for changes in condition.

The facility’s policy regarding falls indicated the staff should not have attempted to move the resident, but instead either summoned emergency medical services (i.e., call 911), or contact the physician for further instructions.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 10
Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
VISIT DATE: 06/24/2025
NARRATIVE
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The facility’s policy regarding falls indicated the staff should not have attempted to move the resident, but instead either summoned emergency medical services (i.e., call 911), or contact the physician for further instructions. The facility staff who assisted R1 after the unwitnessed fall helped R1 off the floor and escorted R1 back to bedroom, which was not in accordance with the facility’s policy for falls. Facility staff stated during investigation that R1 denied having pain when asked. However, records review indicated that R1’s primary diagnosis was Dementia (loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities). It is not known if R1 was able to have understood or have been able to verbalize the presence and location of pain. Facility staff also reported that R1 “looked confused” following the incident.

On 8/14/2022, at approximately 7:00–7:30 am, R1 was observed with skin tears, blood on pajamas near elbows, signs of pain and unable to sit up. On the same day around 11:30 am, R1 was admitted to the local hospital. According to medical records, R1 had had a lumbar compression fracture, a mildly displaced left femoral intertrochanteric fracture, and skin tears on both elbows. Medical records also indicate the cause of the injuries was an accidental fall. Additional records review found that the facility’s admission agreement indicated, “This is a non-medical care facility that does not and cannot provide medical, intermediate or skilled nursing care.” In addition, “the following basic services will be provided “Monitoring and appropriate reporting of resident needs and condition to family and physician.” It is unknown what additional change of condition occurred with R1 during the time of the fall until medical care was sought.
R1 passed away on 8/16/2022. R1’s Certificate of Death indicated the immediate cause of death was cardiopulmonary arrest (also known as cardiac arrest when the heart stops pumping blood and breathing stops) and Alzheimer’s disease (a brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks) as the underlying cause. Also, other significant conditions contributing to death were left hip fracture, and L-1 (lumbar, part of the spine, and first bone of the five lower back bones) compression fracture.

Based on the investigation, the allegation that facility staff did not seek medical attention in a timely manner for resident is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 10
Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
VISIT DATE: 06/24/2025
NARRATIVE
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Regarding the allegation, neglect/lack of care and supervision resulting in resident sustaining multiple injuries, investigation reveals that on 8/13/2022, facility staff left R1 unattended sitting at the dining table for an unknown period of time. R1 had an unwitnessed fall. Staff returned to the dining room on or around 4:30 pm and found R1 on the tile floor near a door. Staff assessed R1 and transported R1 back to R1 bedroom and put R1 in bed. Emergency services were not contacted for R1 on day of fall. After the fall, R1 did not receive medical care and services until 8/14/2022. In addition, neither R1’s responsible party nor physician were immediately notified by the facility after the unwitnessed fall. Interview and records reveal that R1 had a previous fall in October 2020 and per facility staff, R1’s ability to walk and function with minimal assistance had declined. Facility record review reveals, R1 had primary diagnosis of dementia. In addition, per Physician’s Report, dated 6/03/2021, R1 assessment included but was not limited to indication that R1 was unable to ambulate without assistance, experienced dizziness, was confused/disoriented at times with sundowning behavior (a state of confusion that occurs in the late afternoon and lasts into the night causing various behaviors, such as confusion, anxiety, aggression or ignoring directions, and can lead to pacing or wandering) due to dementia, and required assistance with medication management and daily self-care, including feeding self. R1 also had a visual impairment, glaucoma, (an eye condition that can cause vision loss) of the left eye.

During investigation, a facility caregiver stated that R1 “required a walker but refused or forgot to use it.” Two caregivers also stated that R1 required assistance to the dining area by physically holding R1 hand/arm and walking near or next to R1 because R1 was weak and at risk of falling. In addition, R1 was at risk of choking, yet R1 was left unattended in dining room with food in front of R1.

In addition, facility admission agreement for R1 indicates that basic services such as “Assistance with activities of daily living: care and supervision which includes assistance with medication, dressing, toileting, bathing, grooming, mobility, telephoning, and correspondence; central storing and distribution of medication will be provided."

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 10
Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
VISIT DATE: 06/24/2025
NARRATIVE
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Based on the investigation, the allegation of neglect/lack of care and supervision resulting in resident sustaining multiple injuries (fractures) is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met. In addition, this violation posed an immediate Health and Safety risk to resident(s) in care. An Immediate Civil Penalty of $500 is being assessed. The Administrator was also informed that an enhanced civil penalty may be assessed based on Health and Safety Code § 1569.49

Regarding the allegation, Neglect/lack of care and supervision resulting in resident sustaining skin tears, investigation reveals on 8/13/2022, R1 was observed with skin tears, blood on pajamas near elbows, signs of pain and unable to sit up. On the same day around 11:30 am, R1 was admitted to the local hospital. According to medical records, R1 had had a lumbar compression fracture, a mildly displaced left femoral intertrochanteric fracture, and skin tears on both elbows. Medical records also indicate the cause of the injuries was an accidental fall. R1 fell while in care and sustained skin tears on the elbows. Staff denied seeing the skin tears the night before when they conducted a body check after the fall. Staff did not call 911, family, or a supervisor to report the fall.

Based on the investigation, the allegation of neglect/lack of care and supervision resulting in resident sustaining skin tears is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met.

Regarding the allegation, facility staff did not inform authorized representative of resident's injuries, the investigation reveals that on 8/13/2022, R1 had an unwitnessed fall. Staff found R1 on the tile floor of the dining room. Staff assessed R1 and transported R1 back to R1's bedroom and put R1 in bed. At the time of the fall (incident), it was found that R1 had been left unattended. Emergency services were not contacted for R1 on the day of the fall. Neither R1’s responsible party nor physician were immediately notified by the facility after the unwitnessed fall. In addition, facility staff revealed that night shift was not informed that R1 had an unwitnessed fall during the day. On 8/14/2022, R1 was observed with skin tears, blood on pajamas near elbows, signs of pain and unable to sit up. On the same day around 11:30 am, R1 was admitted to the local hospital.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 10
Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
VISIT DATE: 06/24/2025
NARRATIVE
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According to medical records, R1 had had a lumbar compression fracture, a mildly displaced left femoral intertrochanteric fracture, and skin tears on both elbows.

Review of facility's admissions agreement reveals basic services includes, "monitoring and appropriate reporting of resident needs and conditions to family and physician."

On 8/15/2022, staff received disciplinary counseling for not reporting R1’s fall to family, appropriate supervisor, and not following facility’s fall policy to call 911 emergency services. An incident report dated 8/15/2022 shows R1 had an unwitnessed fall in the dining room but did not include signs of pain or injuries.

Based on this investigation, the allegation of facility staff did not inform authorized representative of resident's injuries is Substantiated. A substantiated finding means that the allegation is valid because the preponderance of evidence standard has been met.

An exit interview was conducted where reports (LIC9099-A, LIC9099-C, LIC9099-D, LIC421M) where discussed and provided with appeal rights to Administrator Woofter at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 10
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
06/26/2025
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1... residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs...delivered by staff that are sufficient in numbers, qualifications, and competency...This requirement is not met as evidenced by:
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The Licensee/Administrator has a agreed to conduct inservice training on regulation cited an provided documentation of training to the Licensing Agency by POC due date.
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R1 sustained an unwitnessed fall around 4:30pm on 8/13/22. It was not until around 11:30 am on 8/14/22, when R1 received medical care to meet R1 injuries (needs). Licensee did not ensure that R1 received care and supervision to meet R1 needs. On 8/13/2022, R1 was left unattended by staff in the dining room, for an unknown period of time. R1 sustained multiple fractures and skin tears. Medical records indicate the cause of the injuries was a fall. This posed an immediate health, safety and personal rights risk to residents 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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 10
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
06/26/2025
Section Cited
CCR
87466
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Observation of the Resident .
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional...functioning... appropriate assistance is provided when such observation reveals unmet needs. When changes such as...deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by:
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The Licensee/Administrator has a agreed to conduct inservice training on regulation cited an provided documentation of training to the Licensing Agency by POC due date.
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Staff observed R1 with skin tears, unable to sit up without pain and did not notify R1 physician regarding changes in the R1's condition. This posed an immediate health, safety, and personal risk to residents 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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 10
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20220909164619
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRASWELLS YUCAIPA LEISURE MANOR
FACILITY NUMBER: 360900100
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
06/26/2025
Section Cited
CCR
87507(f)
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Admission Agreements(f)The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by:
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The Licensee/Administrator has agreed to provide inservice training on regulation cited and submit documentation of training to the licensing agency by POC due date.
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Staff received disciplinary action for not appropriately/immediately reporting falls and injuries (condition) to R1's authorized party and physician. Admissions agreement reveals basic services includes, "monitoring and appropriate reporting of resident needs and conditions to family and physician". This posed a potential health, safety, and 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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2025
LIC9099 (FAS) - (06/04)
Page: 10 of 10