Facility Evaluation Report

Licensing Prigram Analyst (LPA) Alviso conducted a case management inspection, on 11/6/25 at approximately 9:45am, and met with Administrator Karina Tapia, and Cheyenne Flores, LVN/Health Services Director.

The case management is being conducted to review three (3) resident incident reports the facility Administrator reported to the Department.

An incident report was received on R1 & R3 regarding reported of abuse by R3. A required SOC341, suspected elder/adult abuse report was reported as required. The Department received both reports. Per interview and review of records, the facility addressed the reported resident incident appropriately. Administration staff is continuing to follow-up to help ensure residents', R1 & R3's, health and safety. Facility will update the Department when required/as required.

Incident regarding R2 who AWOL the memory care unit from the patio/courtyard door to the outside;The door is an egress exit, pressing on it for time required will release it, alarm sounded which alerted staff, who found R2 in the parking lot,this occurred on 10/31, at 5am. Incident of R2 on 11/2 AWOL out the memory care unit door that is inside the building leading into the assisted living area. R2 approached the front lobby area, and was redirected by staff back to the memory care. Only staff have the key code to the memory care door leading into the assisted living area.

In review of the incidents of R2 that occurred on 10/31 & 11/2, a deficiency will be cited, 87705(e)(7) Care of Persons with Dementia- Licensees that use delayed egress devices on exterior doors and perimeter fence gates shall meet the following initial and continuing requirements: Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents, including staff needed to escort residents who need supervision to leave the facility, see LIC809D.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided with report.

Exit interview conducted with Cheyenne Flores, LVN/Health Services Director.