Follow-up on corrections·September 10, 2025

On 9/10/25 at 9:02 AM Licensing Program Analyst (LPA) Cynthia Tamayo conducted an unannounced case management inspection to address previous incident reports and deficiencies in facility operation. LPAs met with administrator, Tevita Kaloulasulasu (S1) and together discussed incident reports from 8/29/25. LPAs conducted file review and observed LIC 603A physician's report is dated 12/21/2023 and Resident 1 (R1) is need of an updated version. S1 stated R1 has an appointment with physician to get an updated physicians report on 11/11/25. Based on LPA observations, interviews, and resident file review, LPA has determined, based on resident needs, there must be awake night staff available at the facility to meet resident needs during overnight hours. S1 stated they are asleep overnight. Staff performing overnight duties must be awake during all hours of the overnight shift. The department has determined the facility did not meet resident needs for care and supervision per the current Personnel report (LIC 500) and residents with diagnosis with dementia. This was documented by an incident report dated 8/29/25 where R1 eloped from the facility and the resident's physician report indicated that resident is unable to leave the facility unassisted. The department received an incident report from 8/27/25 regarding Resident 3 (R3). Staff will obtain updated physicians report and complete a re-appraisal this month. Staff stated R3 and R4 are able to perform their own glucose testing with blood specimens, and is able to administer own medication including medication administered orally or through injection. Continued on 809-C S1 stated they are seeking to obtain home health nurse assistance for R3 to have an appropriately skilled professional start to assist R3 with checking their blood sugar due to R3 being blind and need for a re-assessment. Based on LPA observations, interviews, and resident file review, LPA has determined, special diet is not being followed for residents with diabetes. Per California Code of Regulations, Title 22, the following deficiencies are cited during today's inspection. An Immediate $500 civil penalty was issued during today's inspection. Exit interview conducted and a copy of this report and appeal rights were left at the facility.