Follow-up on corrections·November 14, 2025

Licensing Program Analyst (LPA) Valeria Conway conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20251107111518). LPA arrived at 9:40 A.M. and met with facility staff, Mis “Nana” Sunariyati, who contacted via telephone facility administrator. At 10:15 A.M. Facility Designee Karthiga (Karthi) Vijayakumar and Administrator, Shila Pandey arrived at the facility. The purpose of the report is to issue citations for deficiencies observed during the initial complaint investigation. Entrance interview conducted. During today’s visit, the LPA conducted a brief plant tour at 10:20 A.M. to ensure there are no health and safety concerns, conducted interviews with the Administrator and facility designee, two (2) staff members, and three (3) residents between 10:00 A.M. and 1:30 P.M., conducted a resident file review, and obtained copies of relevant documents. During the course of the investigation, LPA requested Resident’s #1 (R1’s) file. LPA observed that R1 was admitted in January 2024 and that the facility completed an appraisal/needs and service plan in August 2024. The need and services plan for 2025 was observed to be a duplicate of the 2024 document, with the only difference being that the last page was dated 8/11/2025. LPA further observed that the facility indicted progress notes were used as a method of evaluating the resident’s progress, however, when the LPA requested these notes, the administrator stated that neither management nor staff are keeping progress notes and that the forms need to be revised and completed accurately. Continued on LIC 809-C Continued from LIC 809 Additionally, at approximately 1:25 P.M., LPA interviewed Resident #2 (R2) in their room. During the interview, the LPA observed R2 seated in a recliner chair and noted that there was no bed in the room. R2 stated that they prefer to sleep in the recliner and do not wish to use a bed. While on site, a family member of R2 arrived and informed LPA that this has been R2’s long-standing preference and that they have slept in a recliner for many years. LPA revied R2’s physician’s report, which indicated that R2 must use a medical recliner to sleep. LPA asked the administrator whether an exception request had been submitted to the Department; however, the administrator confirmed that an exception had not been submitted. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.