Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Andrew Villegas, Nurse Supervisor and explained the purpose of the visit. Shortly after, LPA met with Jeremiah Hovsepian Bearce, Executive Director and Eusebio 'Sev' Tienda, Director of Wellness who both assisted LPA with the inspection. The facility is licensed to serve (200) non-ambulatory residents age 60 and above. Hospice waiver approved for (6) residents and Memory Care approved for (12) residents. Facility is approved to lock both exterior doors on the perimeter gates in the Memory Care unit (Hacienda Bldg.). Facility is a Continuing Care Retirement Community (CCRC) which includes separate buildings throughout the premises. The Assisted Living residents are located in the Memorial Lodge (ML) and Shu Lodge (SL). Memory Care Unit which is located in the Hacienda Building, is approved for 12 residents. Currently, there are 29 residents in the Assisted Living, 10 residents in Memory Care and 107 residents in Independent Living.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility's Infection Control Plan was recently reviewed and updated on 03/17/2025. Staff are adhering to infection control requirements. The facility allows visitors, such as ombudsman and advocacy representatives to see residents privately at reasonable hours and without prior notice.

Operational Requirements: T he Infection Control Plan has been included to the Plan of Operation. Hospice Waiver for 6 is approved and there are (6) residents receiving hospice care, (0) bedridden . A fire clearance is in place. Fire Drill was last conducted on 03/13/2025. Liability Insurance is in place and expires on 01/01/2026.

Physical Plant & Environment Safety: LPA toured the physical plant areas inside and outside and was accompanied by Andrew Villegas, Nurse Supervisor. The facility is a gated community with multiple single story buildings to accommodate Memory Care, Assisted Living and Independent Living residents, all arranged in a campus-like setting. LPA toured a random selection of resident rooms in the Assisted Living (Memorial lodge and Shu lodge) and Memory Care unit (Hacienda bldg.). Resident rooms were furnished appropriately. Each resident room has their own bathroom. The bathrooms were observed to be clean, operational w/grab bars and have slip-resistant mats. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines. The facility has central air and heating accommodations. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. There are various yard areas throughout the facility that are equipped with patio furniture for residents' comfort and safety. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility are operational and compliant. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. ***CONTINUED ON LIC-809-C***