Nikkei Senior Gardens

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the Community Relations Director (CRM), Kristeen Minami, and explained the reason for the visit. With the assistance of the CRM, LPA conducted a tour of the physical plant at approximately 8:30am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a two story building. There is a memory care with a delayed egress. Egress was checked, and opens after a fifteen second delay at the door. Required postings were observed at the entry and common areas. The smoke alarms and carbon monoxide are dual and interconnected. There are additional carbon monoxide detectors, that were also observed in resident rooms and in common areas. LPA observed fire extinguishers throughout the physical plant on the first and second floors. Charge date is August 15, 2025. Last fire safety inspection was conducted on March 3, 2026. Bedrooms: Personal accommodations in resident bedrooms were observed for safety, privacy, and comfort. Resident rooms were properly furnished with appropriate beddings, linens, sufficient lighting and closet space. Emergency pull chords were tested for proper function. Bathrooms: Resident bathrooms were properly supplied and had functional fixtures, grab bars, and non skid mats or flooring. Hot water temperature in resident bathrooms on both the first and second floors were checked and measured between of 111°F to 114°F. Kitchen: The kitchen appliances and fixtures were functional. Refrigerated and frozen foods were stored at proper temperatures. There was a sufficient amount of perishable and non-perishable food properly stored. LPA observed a listing for residents that require a special diet posted on the kitchen wall. Food deliveries are made once a week. There were no pesticides or poisons observed near any food areas. Kitchen is observed to be clean, safe and sanitary at the time of the visit. Medications: Medication Center is on 1st floor. Medication carts used for medication were observed to be locked and inaccessible to residents. First aid kits located in the medication center and at lobby desk. Medications and medication records were reviewed for proper storage and documentation. Dining room/Resident Lounge/Common areas: Common areas were observed to be adequately furnished with adequate seating, couches, tables and chairs. Activity and exercise rooms were clean and safe. There is a salon and movie theater on the second floor. Laundry: There are two laundry rooms on the first floor. One laundry room is for staff to do provide laundry service for the residents in care. The second laundry room gives the resident an option to do their own laundry. No cleaning supplies or detergents observed during the inspection. Outside/Grounds: Surrounding grounds and the outside areas were observed to be free from obstruction. Patio area has outdoor furniture appropriate for outdoor use. There is a garden, putting green and basketball court available for resident use. There is sufficient space to hold outdoor activities. There is no swimming pool or any other bodies of water. Resident Files: Resident files are kept locked in the medication center. LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: Staff files are also kept locked in the medication center. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.the state’s words, verbatim · CDSS document, Mar 21, 2026

Type of visit: Required - 1 Year

On 1/23/2025, Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced annual inspection. LPA met with Business Office Director, Ericka Rivas disclosed the reason of the visit. There are currently 79 residents who reside at this facility. This facility has a hospice waiver for 15 residents. At approximately 11:30am, LPA toured the facility with Ericka Rivas and the maintenance director, Alfonso Marron. Facility is designated by two resident areas which is the assisted living area and a memory care unit area. In the assisted living unit area, LPA inspected five (5) resident bedrooms, the kitchen, the dining area, an activity room, the theater room, the solarium also known as the tv room, laundry rooms and a gym. In the memory care unit LPA inspected three (3) resident rooms, the mini kitchen area and the activity room. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and were properly stored. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Kitchen has industrial refrigerators and a large food pantry. All the foods in the refrigerator and pantry are labeled and dated. LPA observed the walk-in freezer maintaining the required temperature of 0 degrees Fahrenheit Resident bedrooms and bathrooms: Bathrooms and bedrooms were clean and in good repair. LPA observed clean beds, lamp, night stand, chair and a desk with a desk chair. Hot water temperature was tested and ranged from 107.5 degrees F - 110.7 degrees F. Signal system checked and observed operable during visit. Continued to LIC809C Common Areas: The dining area, the activity room, the theater room, the solarium also known as the tv room, and the gym were observed to be clean. Furnishings observed to be in good condition. No obstructions, nor tripping hazards observed. Laundry Rooms: LPA observed two (2) laundry rooms in the facility. Laundry rooms were observed to be clean and inaccessible to residents. Cleaning supplies, and other toxins, were securely stored and inaccessible to residents. Outdoor: There are various sitting areas surrounding the facility. LPA observed these areas to have more than adequate shade, with sufficient tables and chairs for the residents. All outdoor furniture observed to be in good condition. There are no bodies of water in the facility. In addition to the physical plant inspection, residents records, staff files and resident medications were reviewed between 1:00pm to 4:00pm. LPA reviewed five (5) staff files, all appeared to be complete and updated. LPAs reviewed ten (10) resident records all appeared to be complete and updated. Medications: Residents medication are centrally stored in the medication room which is inaccessible to the residents. Three (3) centrally stored resident medications were reviewed with Samantha Orduna, Health and Wellness Director. First Aid kit was also observed and it is complete. Administrative: LPAs collected a copy of Administrator's certificate of Shin Ito. Certificate of Liability Insurance effective until 12/01/25, LIC500 and LIC9020. Facility emergency disaster plan was reviewed. Fire extinguishers are located all throughout the facility and were last serviced 08/02/2024. Fire Drill was last conducted on 12/20/2024. Fire alarms, smoke detectors and carbon monoxide detectors observed through out the facility and were recently tested on 7/01/2024. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jan 23, 2025

Allegation investigated: Staff did not seek medical attention for resident

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit and met with Business Office Director Erika Rivas, who was informed the reason of the visit. The following information was provided during the complaint investigation: During today’s visit, from 945am to 1pm, LPA conducted interviews and obtained and reviewed resident records. It was alleged staff did not seek medical attention for resident #1 (R1). It was revealed to LPA, that R1 recently developed a cough, that did not heal. R1’s family representative, home health agency, and primary physician was notified, and prescriptions were ordered for R1. Although it was reported, facility staff did not seek medical attention for R1, it was reported to LPA, that R1 was treated for the cough, and a chest x-ray was performed to ensure there were no further medical issues. Therefore, based on interviews, LPA does not have sufficient evidence to prove the allegation, and it’s deemed Unsubstantiated at this time. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 23, 2024 · control 31-AS-20240419102003

Type of visit: Required - 1 Year

On 01/02/2023 at 12:55 PM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Executive Director Shin Ito and disclosed the purpose of this visit. At 01:10 PM LPA Alemoh conducted a physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Facility is licensed to serve elderly residents aged 60 and above. Facility is cleared for 66 non ambulatory and 40 Bedridden residents. Facility is licensed to house separate Dementia wing and delayed egress. Facility is approved the facility also has an approved hospice waiver for 10 (10) residents. The Annual Licensing Fees are current. Facility has a coded gate. Facility is a two-story building. Parking lot located on the east side of the building and wraps along property. The Executive Director accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. LPA observed ten (10) Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. LPA observed Ten (10) Resident bathrooms at random. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 106F-118F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA observed hand washing signs in all restrooms. Common areas were clean and clear of hazards, doorways were free of obstructions. Facility has two laundry rooms; one is designated for staff. Both are equipped with two industrial sized washer/ dryer all appliances, in good working order at time of visit. Cleaning agents secured and inaccessible to residents. LPA toured the kitchen area and observed a two day supply of perishable and a seven day supply of non-perishable food. Knives were kept in locked secure area locked. Appliances observed to be in good repair and functioning. Toxins stored in 1st floor janitors’ area and 2nd floor storage closet observed to be locked an inaccessible to residents in care. First Aid kit and manual was located near the administrator desk. There are multiple fire extinguishers in the facility. Extinguishers were observed to be charged with receipt dated Oct 1st 2023. Dual Smoke alarms and carbon monoxide are hardwired and interconnected, were tested and observed to be operable. Facility also has a sprinkler system. Fire/earthquake both tested quarterly. At 2:30 PM LPA conducted a file review. 9 staff records were reviewed, 9 out of 9 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. 9 resident records were reviewed and, 9 out of 9 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. LPA met with Pharmacist Samantha Orduna in the medication room. The room is equipped with industrial sized medication carts, used to disperse resident medications. All med carts were observed to be locked and inaccessible to residents. First aid kits located in the medication center and at lobby desk. No deficiencies cited. An exit interview was conducted. A copy of this report and appeal rights were left with Executive Director Shin Ito.the state’s words, verbatim · CDSS document, Jan 2, 2024