Routine inspection·October 21, 2025

On 10/21/2025, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced annual inspection at the above-referenced facility to evaluate compliance with California Code of Regulations, Title 22. Upon arrival, LPA met with care staff Mereisi Naisausau and explained the purpose of the visit. LPA requested that the facility designated administrator (FDA) be contacted to notify the Community Care Licensing Division (CCLD) presence. Care staff stated she did not know who the current administrator was and reported that she had been scheduled to work at the facility by an individual named Charles (last name unknown). Approximately two hours later, Veresa Taqasi arrived and identified himself as the Assistant Administrator. He provided the staff files for Mereisi Naisausau and Luisa Biu. The census is 6 with 1 staff. The facility is a single-story building licensed to serve six non-ambulatory residents, with hospice waiver approval for two residents. LPA conducted an inspection of the physical plant, including the common areas, kitchen, dining area, resident bedrooms and bathrooms, laundry room, garage, and outdoor courtyards. The facility was observed to be clean and free of odor but was observed not in good repair due to broken tiles in the kitchen that posed a tripping hazard. There was no incontinence odors observed during the inspection. Resident bedrooms were properly furnished with appropriate bedding and adequate lighting. No bodies of water were present on the premises. The kitchen contained a sufficient supply of food, including a seven-day supply of non-perishable items and a two-day supply of perishable items. The hot water temperature measured in a resident bathroom sink was 113.4 degrees Fahrenheit, which is within the regulatory range of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mats in the bathrooms were stable and in good condition. CONTINUED LIC 809-C Smoke and carbon monoxide detectors were operational and compliant with fire safety regulations. A fire extinguisher located in the common area was last serviced on 05/12/2025. The facility thermostat was observed to be set at 72 degrees Fahrenheit. A public telephone was located in the kitchen. During the garage inspection, the door was found to be unlocked, and multiple toxic substances were accessible to residents. These included multipurpose cleaner, tire shine spray, five paint cans, two toilet bowl cleaners, a Comet deodorizing cleanser, and a super oxygen bathroom cleaner. Sharp knives were properly stored and locked away, making them inaccessible to residents. Medication storage was found to be unlocked and accessible to residents, which is not in compliance with regulations. LPA reviewed medication for 3 of the 6 residents along with their Medication Administration Records (MAR), and the documentation was completed. The first aid kit was checked and found to contain the required components. LPA reviewed all 6 resident files, which were complete and up to date. 3 staff files were reviewed and found to be complete. A review of criminal record clearances indicated that all facility staff and individuals requiring caregiver background checks were fingerprint cleared and associated with the facility. During the visit, LPA addressed concerns regarding the facility’s administrator. Assistant Administrator Taqasi stated that Filipe Naikas is the new administrator; however, LPA was unable to verify Filipe Naikas as an administrator associated with the facility in CCLD records. It was learned that Administrator Barbara Williams had not been present at the facility following an incident related to complaint control number 27-AS-20250731120824 and a case management visit dated 08/ 05/ 2025. This matter is currently under follow-up as part of complaint control number 27-AS-20251015132407. LPA also informed Assistant Administrator Taqasi that the facility’s annual fees were due and provided the PIN number for payment. The following documents will be emailed to LPA by 10/31/2025 at the end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report CONTINUED LIC 809-C During today’s visit it was brought to LPA Lee’s attention that there were no staff on site on 10/20/2025 at approximately 5:00 PM. Based on interviews with residents in care, facility staff and residents family it is unclear whether staff were in the facility or not. Statements from residents, staff and residents’ families are contradictory. As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with Assistant Administrator Veresa Taqasi, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.