Nina's Home

Obtain baseline medical assessment before resident admission

Based on record reviewed, the licensee did not comply with the section cited above in 1 of 3 resident files was observed medical assessment with a date of 6/6/24 and not completed within the last year. This poses a potential health, safety or personal rights risk to persons in care.

Food storage temperature control requirements

Based on LPA observation, the licensee did not comply with the section cited above in that the freezer in the garage was leaking water and measured at 13 degrees F and the freezer inside kitchen measured at 8 degrees F. This posesd a potential health, safety or personal rights risk to persons in care.

Limit operations to licensed capacity

Based on record reviewed, the licensee did not comply with the section cited above in 3 of 5 residents are receiving hospice services. The facility has a hospice wavier for 2 residents. This poses an immediate health, safety or personal rights risk to persons in care.

Prohibit false or misleading facility statements

Based on interviews conducted and records reviewed, the licensee did not comply with the section cited above in that False statement(s) made by S2 and Licensee to LPA regarding R2's testing/injections being completed by a family member and by S2 regarding home health services being provided for R1. This poses an immediate health safety and or personal rights risk to residents in care.

Based on observation, the licensee did not comply with the section cited above in that Personal rights, nondiscrimination notice and complaint information is not posted at the facility. This poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in the emergency disaster plan did not have assembly points identified on the facility sketch. One shelter location not outside the immediate area. Disaster drills are not being conducted quarterly. This poses which poses a potential health, safety or personal rights risk to persons in care.

Facility must clear fire safety for bedridden persons

Based on observation, the licensee did not comply with the section cited above in 2 of 5 residents were observed with a trapeze assistive device over their beds. Facility does not have a fire clearance for bedridden residents. This poses an immediate health, safety or personal rights risk to persons in care. *****An immediate civil penalty in the amount of $500 is assessed.****

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above in that the water temperature measured at 128.8 degrees F. This poses a potential health safety and or personal rights risk to residents in care.

Based on LPA observation, the licensee did not comply with the section cited above in 3 of 6 oxygen tanks observed in closet off kitchen were unsecured. This poses an immediate health, safety or personal rights risk to persons in care.

Allowing diabetic residents based on self-management ability

Base on interviews conducted and records reviewed. The licensee did not comply with the section cited above in that R2’s medicatin log showed staff are providing testing/injections. Interview with R2 indicated staff are assisting with both testing and injections. This poses an immediate health safety and or personal rights risk to resident(s) in care.

Based on record review, the licensee did not comply with the section cited above in that the facility administrator on record, Leticia Rodriguez, was no longer working with the facility as of 10/15/2024. On 12/30/24 Licensee submitted a request, to change administraor to Phouen Marez. Licensee was notified the request was missing a letter appointing new administrator, LIC 308 and LIC 9182. Effective 9/9/25, Phouen Marez, was no longer working with the facility. A new request was submitted to change administrator on 12/31/25 to Shemeka Turner. However, the request is incomplete and missing a resume and a letter appointing the new administrator. From 9/9/25 to 12/31/25 the facility has not had an active administrator. This poses an immediate health, safety and or personal rights risk to residents in care.

1569.185 Fees for license or applications; use of revenues; collected; denial or forfeiture (b) (1) In addition to fees set forth in subdivision (a), the department shall charge all of the following fees: (F) A late fee that represents an additional 50 percent of the established current annual fee when a licensee fails to pay the current annual licensing fee on or before the due date as indicated by postmark on the payment. This requirement was not met as evidence by: records reviewed. The licensee did not comply with the section cited above in that the Licensee did not pay the current annual and past due fees associated to facility. This poses a potential health safety and or personal rights risk to residents in care.

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). (c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidence by: LPA observation and record review. The licensee did not comply with the section cited above in that R1's MARs shows 2 injectable medications were not provided to R1 (2x on 9/18/25). This poses an immediate health safety and or personal rights risk to residents in care.

Require fire clearance before non-temporary bedridden admission

(c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. This requirement was not met as evidence by: record review, interviews and LPA observations. The licensee did not comply with the section cited above in that the facility has a hospice wavier for 1 resident. 3 residents at the facility are currently receiving hospice care. 2 of 3 residents on hospice observed to have grab bar (trapeze) above their bed to assist in repositioning. This poses an immediate health safety and or personal rights risk to residents in care.

Allowing diabetic residents based on self-management ability

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement was not met as evidence by: records reviewed. The licensee did not comply with the section cited above in that R1 is receiving injectable medications they are unable to provide to themselves and a medical professional is not providing. This poses a potential health safety and or personal rights risk to resients in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: LPA observation of tear in carpet near transition from living room to kitchen in need of repair. Transition from living room to kitchen in need of replacement. Carpet in master bedroom doorway was lifted and in need of repair. Outside back patio observed with moss in need of cleaning. Refrigerator in garage leaking liquid in need of replacement. Garage observed with clutter in need of removal.

Right to sufficient care and qualified staff

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidence by: LPA observation and interviews conducted. Observation of S1 and S2 utilizing a translation device to communicate with residents, visitors and other staff.

Based on LPA observation of the following: Living room carpet has hole near transition from living room to kitchen. Dog urine in master bathroom. Master bedroom has dirty brief. Carpet in master bedroom doorway was lifted and in need of repair. Flooring in hallway bathroom observed lifting and in need of repair. Bedroom #3 observed with paint in need of touch up near nightstand. Inside refrigerator observed with liquid at the bottom in need of cleaning. Inside refridgerator missing racks in freezer. Hole in garage behind door in need of repair. Debris observed behind washer and dryer in need of cleaning. Left side gate is not self-latching. Concrete on patio observed with moss in need of cleaning. Refridgerator in garage leaking liquid. Freezer observed with severe frost bite and refrigerator missing shelves in need of replacement/repair. Garage door observed dirty and in need of cleaning. Garage observed with clutter in need of removal. The licensee did not comply with the section cited above. This poses a potential health, safety or personal rights risk to persons in care.

Based on LPA observation, the licensee did not comply with the section cited above in that the facilities disaster prepardness plan was present but not updated with accurate information. This poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on LPA observation of water temperature measuring at 129.7 degrees F, the licensee did not comply with the section cited above. This poses a potential health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on LPA observation, the licensee did not comply with the section cited above in scissors being observed in the nook area drawer unlocked and accessible to residents in care. This poses a potential health, safety or personal rights risk to persons in care.

Diet quality and preparation in safe healthful manner

Based on LPA observation facility did not have the required 7-day non-perishable food supply, the licensee did not comply with the section cited above. This poses an immediate health, safety or personal rights risk to persons in care.

Store disinfectants separately from food supplies

87309 Storage Space(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1)Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement was not met as evidence by: LPA observation of pictures provided by RP of medications unlock in a dresser drawer, medications unlocked in the facility refrigerator and drawers during a visit on 4/19/24.

Diet quality and preparation in safe healthful manner

87555 General Food Service Requirements(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidence by: LPA observations on 4/19/24 of expired food in the pantry, improperly stored food in refrigerator/freezer and observed staff cooking. Interviews conducted with residents indicated residents do not have a variety of food served that is meeting their dietary needs.

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record This requirement was not met as evidence by: LPA observation of S1 working at facility and Licensee not ensuring all staff present at the facility have received criminal record clearance and been associated to the facility. This poses an immediate health, safety and/or personal rights risk to residents in care.

1569.153 Theft and loss program; standards, property inventories and surrender of personal effects; secured areasA theft and loss program shall be implemented by the residential care facilities...include all of the following:... A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility... This requirement was not met as evidence by: LPA’s review of the admission agreement and interview with RP disclosing R1 and R2 did not discharge with all of their belongings/medication/supplies.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by LPA observation of MARS reviewed from 4/1/24-4/12/24 showing R1 did not receive their medications as prescribed. It was also observed that R1 was not being provided liquids with thicken during a visit conducted on 4/19/24.

Right to personal privacy in daily care

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a)...(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance... This requirement was not met as evidence by: LPA interviews disclosing staff are taking photographs/videos of R1 without consent. LPA observation of staff walking into residents’ rooms without permission to enter. Moving R1 in a rough manner without explanation. Raising their voices at R2 during visit on 4/19/24.

87705 Care of Persons with Dementia(c) Licensees who accept and retain residents with dementia... (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs...(A)... shall have at least one night staff person awake and on duty... This requirement was not met as evidence by: LPA interviews staff they are sleeping during the night shift. Documentation reviewed shows R1 wanders throughout the night and R2 needs assistance with their medical condition.

1569.681 License number; use in advertisements, publications or announcements (a) Each residential care facility for the elderly licensed under this chapter shall reveal its license number in all advertisements, publications, or announcements made with the intent to attract clients or residents. This requirement was not met as evidence by: based off of interviews conducted it was found that Licensee is advertisements, publications or announcements for the elderly licensed facility without the license number.

1569.46 Operation of unlicensed facility as unfair competition and unfair business practiceOperation of an unlicensed facility shall be an act of unfair competition and an unfair business practice within the meaning of Chapter 5 (commencing with Section 17200) of the Business and Professions Code. This requirement was not met as evidence by: based off of interviews conducted it was found that Licensee is running unlicensed homes and providing care and supervision to residents/clients.

Admission agreement signing and dating deadline

87507 Admission Agreements: (c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission. This requirement was not met as evidenced by: Based on records review, the licensee failed to ensure that the admission agreement was signed and that the agreed upon monthly rate was clearly communicated in writing.

Safe, healthful, comfortable accommodations

87468.1(a)(2) Personal Rights of Residents in All Facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews and records reviewed, the Licensee failed to provide Resident 1(R1) with accomodations per R1's admission agreement. This presents a potential health and safety risk to residents in care.

87217(i) Safeguards for Resident Cash, Personal Property, and Valuables: Upon discharge of a resident, all cash resources, personal property and valuables of that resident which have been entrusted to the licensee shall be surrendered to the resident, or his responsible person. This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee failed to return all of R1's property to her responsible party upon discharge from the faility.

87464(f)(3) Basic Services: Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets prescribed by a doctor... This requirement was not met as evidenced by: Based on interviews and records, facility staff served R1, who is lactose-intolerant dairy products. This presents a potential health and safety risk.