Routine inspection·January 14, 2026

On 1/14/2026 Licensing Program Analysts, (LPAs) LaVette Farlow and Michelle Echeverria arrived at the Nick's Maple Home III, unannounced to conduct an Annual Inspection. LPAs was greeted by Caregiver, Michelle Manaoang. LPAs introduced self and stated purpose of the visit and was granted entry. Caregiver Michelle notified Administrator, Ahmad Abdallatef of LPAs arrival. LPAs were provided space to work, and conducted a tour of the facility. Administrator Ahmad, and House Manager Malik Salem arrived later and participate during the inspection. Facility: The facility is two (2) story home. It home is a 5 bedrooms, 1 of the 5 bedrooms is for staff, a kitchen, two, (2) living room areas, dining room, laundry space, backyard and attached garage. The facility is approved for a capacity of 10. The facility is approved ten (10) of which eight (8) ambulatory two (2) non-ambulatory. The current census is ten (10). There is a hospice waiver in place approval for 2. The temperature throughout the facility is a comfortable 76 degrees. The facility is equipped with operational smoke alarms, and carbon monoxide detectors. LPA observed two fully charged fire extinguishers. Each one was last inspected October 7, 2025. The facility water was tested and the temperature ranged from 127.9, and 122.3, a technical violation issued. Resident Rooms - Each resident bedroom can accommodate any ambulatory resident. All resident bedrooms were adequately furnished with bed, storage space, chairs, and lighting. Please see LIC809-C Bathrooms: All bathrooms contained working appliances and adequate hand hygiene and paper supplies. Hand rails and non-slip grip materials were observed near toilets and in showers/tubs. Kitchen - The facility contained an adequate supply of dry goods, canned goods and non-perishable items for the amount of residents in care. Sharp objects, chemicals/cleaning supplies are maintained and secured in a cabinet near the front door. Additional food items such as milk, bread, eggs, fresh fruits, condiments, cheese, cookies, ice cream, cereals and meats were located in the kitchen refrigerator and two deep freezers in the attached garage. Personnel Records- LPAs reviewed two (2) employees record for first aid certification, finger print clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights and training verification, and current administrator certification. LPAs observed that 1 out of 2 staff records were incomplete and missing a Health screening and TB test results. A Deficiency cited. Resident Records- LPAs reviewed seven (7) resident files for: admission agreements, medical assessments and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPAs observed that the Administrator did not have a physicians' report for one resident who was admitted since November 2025. A deficiency cited. LPAs observed resident Admission report were missing signatures, and some were printed double sided and with white out, and the appraisal and pre-appraisal were missing signatures. A deficiency cite. LPAs observed a first aid kit, and it was complete. Backyard/Outdoor Space: LPAs observed the facility patio, with a shaded area with chairs. The Laundry space was observed en route to the attached garage. It contained operable washer and dryer. ***Continued LIC809C*** LPAs observed the following posters posted throughout the facility: Resident Roster, Resident Rights, Facility License, Emergency/Disaster Plan, Emergency Contact information, Long Term Care Ombudsman, Infection Control and If you see something-say something. Based on the information observations and review of records during this visit today one technical violation and three deficiencies were cited per Title 22, Division 6 of The California Code of Regulations. The report LIC809, LIC809C, LIC809D, and appeal rights were reviewed and a copy provided to Administrator Ahmad Abdallatef.