Correction check·September 29, 2025

On 9/29/2025, Licensing Program Analyst (LPA) Cynthia Tamayo and Licensing Program Manager (LPM) Czarrina Camilon-Lee conducted an unannounced Case Management POC visit to the facility to verify correction of citations issued on 8/12/LPA Tamayo met with facility staff Isikeli Tuikenatabua (S2) and explained the purpose of the visit. Current administrator/Licensee (S1), Cleopatra Gardiner was not present at the facility. S2 called S1. Administrator, Cleopatra Gardiner, was contacted via phone call and informed she will return to the facility next Monday, 10/6/25. S1 stated that S2 will be instated as administrator, and agreed to send request for change of administrator on this day. LPA and LPM met with Direct care staff, Isikeli (S2) Tuikenatabua. The census is 13. LPM spoke with staff regarding ensuring all exits are and staff supervision requirements. Staff 3 (S3), LPA Tamayo, and LPM Camilon-Lee went on a tour of the facility. LPA and LPM observed the garage door was unlocked and there were cleaning supplies and toxins including laundry detergent and medications in the entrance area of the garage, accessible to residents. A deficiency and civil penalty for repeat violation was applied. LPA observed S2 lock garage door immediately. LPM observed staff preparing lunch was frozen corn dogs and pizza. LPA did not observe any snacks to be distributed. LPA/LPM observed the smoke detectors went off when staff where preparing lunch. LPA Tamayo observed the exhaust fan is not working. LPA observed staff preparing dinner around 4:30 PM which included frozen chicken strips, frozen French-fried that were prepared in the oven, and watermelon and melon mix. LPA observed a lock mechanism in a kitchen drawer, S2 stated they used to lock the refrigerator but do not practice doing so any longer. Continued on 809-C Staff 5 (S5) was present and working at the facility on 9/23/25. S5 does not have a staff record for review as required by Title 22 regulations. . LPA obtained for four residents (R1-R4) records and four staff records . Licensee failed to correct an outstanding plan of correction regarding administrator oversight. A civil penalty issued for failure to correct deficiency was last cited on 8/13/2025, in which the original deficiency was cited on 6/30/25. S2 emailed LPA their Administrator Certificate during this visit, however, the LIC 308 designates another staff as responsible representative and the complete POC has not been submitted to LPA Tamayo by the Licensee. As a result of this case management 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 S2 and a copy of these LIC 809 reports, LIC 809-D page, LIC 421FCs, and Appeals rights were provided to the facility.