Follow-up on corrections·January 9, 2026

On 1/9/2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a case management visit. LPA initially met with staff on duty, Carlos Samayoa (S1), and stated the purpose of the visit. One of the facility manager, Apakuki Nawasa (S2), was notified. S2 is unable to come to the facility immediately and designated S1 to assist with the visit. Present during this visit were 5 residents in care with one staff on duty (S1). The Administrator Bulou Matamadua (AD), arrived at 11:45am. During this visit, a resident (R4) had an unwitnessed fall. Prior to the fall, S1 was in the kitchen preparing their lunch meal. LPA heard a loud thud sound and observed R4 lying on the bathroom floor. LPA observed 2 small pieces of countertop tiles on the floor next to R4's head. R4 seizured for about 10 - 15 seconds. S1 called 911 and they arrived about 5 minutes later. LPA overheard S1 reporting to the Emergency Personnel that R4 ran out of seizure medication 2 - 3 days ago. R4 was assessed by Emergency Personnel with no visible injuries. Review of R4's medications confirms R4's medication bottles were empty. Review of R4's medication administration record confirms R4 was out of seizure medications on 1/7/2026. Other medications ran out beginning 1/5/2026. R4 was taken to the hospital for evaluation and for seizure medication. Interview with AD revealed that R4 currently do not have an established primary physician but did not plan accordingly to ensure R4 received their medication refills. Purpose of this visit is to obtain additional files for Complaint# 27-AS-20251112124819. LPA obtained copy of resident files belong to R1 and R2 for further review. LPA obtain copy of facility files, including staff schedule for November 2025, resident roster from November to present, and facility policy on resident drug use and resident rules. R2's documents were not at this facility during this visit. The facility manager had to go to another facility to obtain R2's documents. Purpose of this visit is to recite deficiencies from Complaint# 27-AS-20251208152635. LPA is reciting the facility for not submitting the Plan of Corrections (POC) set on 12/17/2025. Facility was cited for CCR 87464(f)(1) Basic Services and it was due 12/18/25. Facility was also cited for CCR 87468.1(a)(2) Personal Rights of Residents in All Facilities and it was due 12/24/25. The Department did not receive these POCs. Purpose of this visit is to cite deficiencies observed during complaint visit on 12/17/2025 (Complaint# 27-AS-20251208152635). During a visit on 12/17/25, LPA observed a door knob lock on a chair by the front door. LPA asked staff (S3) regarding the door knob lock and stated that they (staff) use a door knob lock to secure the front door knob to prevent residents from opening the front door and going outside. It is a door knob cover with combination to unlock. S3 demonstrated to LPA how they use this device. During today's visit, LPA observed the door knob lock on a dining table located in the living room area. This is a repeat violation. The facility was cited for this violation on 9/11/25 and will be assess a civil penalty of $1000 for repeat violation during this visit. During a complaint visit on 12/17/2025, LPA discovered, through record review and interviews, R4 had an elopement incident occurred on 12/15/25 and emergency hospitalization due to psychiatric problem on 12/1/25. Through LPA's verification, the Department did not receive these incident reports. Based on today's visit, the facility is being cited for deficiencies noted in 9099-D. Additionally, the facility is hereby assessed a civil penalty of $1000 for repeat violation. Facility is hereby assessed additional immediate civil penalty of $500 not ensuring resident received their seizure medication timely, which resulted in seizure and fall. Plan of Corrections and due dates were discussed during the exit interview. Copy of this report and appeal rights were provided.