Review of R1’s communication log indicated that R1 moved to the facility on 10/24/2025. Review of documentation for 10/24/2025 – 10/26/2025 showed that R1 was noted to be restless and agitated. Communication log noted that on 10/26/2025, R1 hit staff when they tried to provide incontinence care. R1’s communication log also stated that R1 was provided their PRN or “as needed” medication for agitation on 10/24/2025 and 10/25/2025. Email correspondence provided to the Department corroborated this information and noted that facility staff attempted to give R1 their PRN medication for agitation but spit it out on 10/26/2025,

Interview conducted with Health and Wellness Director (HWD) stated that the facility was not capable of caring for R1 because they required a higher level of care. Per interview, a reassessment for R1 was done and R1’s responsible party was informed in-person and via telephone of the new behaviors being observed at the facility. Interview further revealed that it was discussed to have additional private caregivers to help assist with R1’s behaviors. Per HWD, the process of eviction was not discussed because R1’s responsible party decided to move them out of the facility.

Interview conducted with Memory Care Coordinator (MCC) stated that they contacted R1’s responsible party multiple times a day to inform them of R1’s observed behaviors such as throwing furniture or running at residents.

Interviews conducted with HWD and MCC revealed that these conversations with R1’s responsible party were not documented or written anywhere because the events happened very quickly over the course of a few days.

Interview conducted with R1’s responsible party stated that R1 did not have any behaviors while living at home and that facility informed them of R1’s behaviors such as throwing food and being violent towards facility staff a few days after they moved to the facility. Per interview, the facility did not discuss with them about R1 requiring a higher level of care or needing additional caregivers for help. Per interview, no additional documents regarding R1 and their care were reviewed or signed apart from the admissions agreement.

Review of R1’s file showed that facility conducted a reassessment on 10/30/2025 for R1 regarding their observed behaviors of aggression and violence. It was observed that this reassessment was not signed by

Continued on LIC9099C

It was also observed that R1, their responsible party, and Community Care Licensing (CCL) did not receive a 30-day eviction notice as required by regulation.

Title 22 Regulations under Eviction Procedures, 87224(a)(4) states, “87224 Eviction Procedures: (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required… (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident."

Based on interviews conducted, record review and observations made, these allegations are Substantiated.

A finding that the Complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, Plan of Corrections, and Appeal Rights, discussed and provided to Executive Director. Signature on form confirms receipt of documents.