Primecare Facility Home

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Elena Mallett conducted an unannounced Annual Continuation visit to complete the CARE tool domains that were not completed during the original visit. The original visit was conducted on 12/29/25. LPA Mallett was met by Administrator Hiransha Keerthisinghe and the purpose of the visit was explained. The facility is licensed to serve 6 Non-Ambulatory Residents, one of which may be bedridden, ages 60 and above, with a hospice waiver for (4) four. Currently none of the residents are bedridden. One resident is on hospice. LPA utilized Compliance and Regulatory Enforcement (CARE) tools for the visit today and for the initial visit. LPA observed the following during today’s visit: Infection Control: Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains current, required liability insurance. Physical Plant & Environment Safety: Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency. (Continued on LIC809-C) Personnel Records-Training: Staff files are kept in a secure area. All staff have criminal record clearances, current First-Aid/CPR/AED training along with annual ongoing Dementia and Care for the Elderly population training documented in personnel files. LPA reviewed 3 staff files with no issues observed. Administrator Hiransha Keerthisinghe certificate expires on 05/13/26. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisals, Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Reports with ambulatory status. LPA reviewed 4 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and has a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a locked closet and are in their original containers. 4 resident medication logs were reviewed with no issues. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. A complete First Aid kit with Manual was observed. Operable emergency lamps were observed. Residents with Special Health Needs: There are no bedridden residents at this time. One resident is using hospice, and a hospice care plan was observed. Three staff and four resident interviews were conducted. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. An exit interview was held with Administrator Keerthisinghe and a copy of this Licensing report was provided.the state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elena Mallett conducted an unannounced, Annual Inspection. LPA met with Caregiver Arnold Prestano and explained the purpose of the visit. Administrator Hiransha Keerthisinghe was contacted by telephone and joined the visit shortly after. LPA Mallett toured the facility with Caregiver Prestano. Copies of resident and employee rosters were obtained. The facility is a in the residential community of Cerritos and is licensed to serve 6 non-ambulatory residents, one of which may be bedridden. The facility has a hospice waiver for 4 but only one resident is currently receiving hospice services. The facility consists of a Living room, kitchen, family room, 4 client bedrooms ( 2 shared) and 2 private and 2 bathrooms. There is a front yard and backyard. The backyard contains a shaded patio area for clients to sit. These areas were free from obstruction and well maintained. The facility hallways and rooms were free from debris and obstructions. There were operable smoke detectors in each resident room and in common areas. There was an operable carbon monoxide detector observed by residents' room. There was a fully charged fire extinguisher present. The kitchen and food supply was observed to have sufficient perishable and non-perishable food as well as operable appliances for food preparation and storage. Knifes and sharps and cleaning supplies and toxins were observed to be locked cabinets. All resident rooms were observed to have required linens and furnishings and light. Extra linen and hygiene supplies were observed. Water in both bathrooms measured within Title 22 Regulations. The CARE Tool was utilized for today's visit. Due to Time constraints only the Physical Plant and Food Service domains were completed. The Annual will be completed at a later time.No deficiencies per Health and Safety Code and Title 22 regulations were observed today. An exit interview was conducted with Administrator Keerthisinghe and a copy of this Licensing Report was provided.the state’s words, verbatim · CDSS document, Dec 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was granted entrance into the facility by S1 and explained the purpose of the visit. Administrator, Hiransha Keerthisnghe arrived shortly after and purpose of the visit was discussed. Administrator assisted with the tour of the facility. There are four (4) residents who currently reside within the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. LPA observed that the facility has a current Infection Control Plan on file in place. Physical Plant/Environment Safety: The facility is part of a single-story home located in a residential area and contains the following: living room, dining room, office room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, (2) private resident rooms, (2) shared resident rooms, garage, (2) bathrooms for residents; bathrooms with shower, toilet, and washbasin. A back yard with shaded area and seating for resident use. There’s a laundry area; with washer and dryer in the garage. The residence is equipped with central air conditioning. There is an inaccessible fireplace. Exit doors are free of any obstruction and there are no pools or large bodies of water. All resident rooms were inspected and LPA observed resident beds and the bedding for each bed were in good condition, adequate lighting provided, storage for resident personal belongings was observed for each resident. Physical Plant/Environment Safety [Cont.]: Each resident bedrooms include all required furniture: a bed, chair, lamps, dressers, and sufficient lighting and closet space. The facility has two (2) fully charged fire extinguishers located one in the hallway and one in the dining room and inspected on 07/09/2024. Sharps were secure and locked in the kitchen drawer and inaccessible to residents. Cleaning supplies were observed in a secured area away from food in the kitchen underneath the sink. Carbon monoxide detector is tested and in working condition. Resident Bathrooms are clean and operational. Toilets and water faucets worked properly. Showers were free of mold/mildew, had adequate lighting, and there are sufficient toiletries that are accessible to residents. Grab bars observed in the bathroom. Bathrooms water temperature was tested as follow: water temperature bathroom #1 tested at 112 degrees F and bedroom #2 tested at 114.3 degrees F which is within the required 105-120 degrees F regulation. Facility temperature was comfortable and cool. LPA observed the facility to be clean and appropriately furnished with clear passageways inside and outside. Operational Requirements: The Program Design was reviewed. This home is licensed to serve age range 60 and over. (6) non-ambulatory, of which 1 may be bedridden. Bedridden in room #4. Hospice waiver for 4. Care and supervision to meet the residents’ needs was observed. Liability Insurance is confirmed and currently on file. Staffing: A total of five (5) full-time staff members provide care and supervision to the residents Personnel Records / Staff Training: Administrator certificate effective on 05/13/2026 and Training in file. Staff have the proper criminal and background clearance. Five (5) staff files for First Aid and CPR training, Personnel Record, Health Screening, TB Clearance, and Employee Rights. All other ongoing training was documented. Resident Rights/Information Physician orders were reviewed in resident files. Personal Rights is posted. Facility provides phone and internet access to residents. Resident Records/Incident Reports: Four (4) resident files were reviewed containing admission agreements, Physician's Report, physician’s orders, medical/functional assessments, TB clearance, Appraisal/Needs and Services Plan, personal rights, pre-placement appraisal, and medication records were reviewed. However, based on record review, Resident #3 (R3’s) medical assessment LIC602 Physician’s Report is signed but not dated and does not indicate the physician’s details nor length of time the resident has been under their care. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Planned Activities: LPA observed facility has sufficient activities and sufficient indoor and outdoor space for planned activities. Facility provides an activity calendar for residents with Dementia. Incident Medical and Dental: Resident medical and dental records in resident files. Facility provides transportation for residents to medical and dental appointments if needed. All medications are centrally stored in a locked closet and are properly labelled and in their original containers. LPA reviewed four (4) residents’ medications with no issues. Disaster Preparedness: Emergency and Disaster Plan was posted on the wall and reviewed. An emergency fire/disaster drill was last conducted on 12/2/2024. Residents with Special Health Needs LPA observed from record review and interview that the facility has no residents with special health needs. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit are documented on the LIC809-D. Exit Interview conducted and a copy of the report with appeal rights were provided to the Administrator, Hiransha Keerthisnghe.the state’s words, verbatim · CDSS document, Jan 31, 2025

Allegation investigated: Covid-19 masking protocols are not being followed. Nurse is being impeded while trying to provide medical care to resident. Resident was not accorded privacy while in care.

Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent unannounced complaint visit to deliver findings to the above mentioned allegations. LPA met with Hiransha Keerthisinghe and explained the reason for the visit. The investigation consisted of the following: On 01/13/22 and 02/23/24 interviews were conducted with the staff and residents. On 2/23/24 PT (Physical Therapist) who was visiting one of the residents (R2) at the facility also were interviewed. Staff and residents’ rosters were obtained, Residents and facility files were reviewed, and relevant documents were obtained. Continue 9099C Unsubstantiated The investigation revealed the following: Regarding the allegation that Covid-19 masking protocols are not being followed, it was alleged: at the time of nurse visit Facility staff were not wearing mask. The administrator and interviewed staff denied the above allegation and stated that all staff when there were mask mandates in order, the facility followed the most up to date regulations and staff always wear masks while working in the facility. Upon reviewing of training materials LPA observed that staff were trained and followed Covid guidelines / protocols for mask use. During the visit LPA observed all staff at the facility to be wearing face masks. Interviewed residents stated they have not witnessed staff not wearing masks and have no concerns about it. Regarding the allegation that Nurse is being impeded while trying to provide medical care to resident, it was alleged: facility staff did not allow the nurse to see the resident and provide treatment without wearing full PPE. The administrator and staff stated that during the Covid period staff tried their best to protect the residents. The administrator and staff stated that staff were trained and followed the Covid guidelines and protocols, and the facility procedure was to wear masks and gowns for all visitors before visiting the residents. The Administrator confirmed that nurses were not impeded while providing medical care to residents, however, were being requested to wear masks and gowns before entering facility / resident’s room. Staff interviews confirmed that medical staff / nurses were allowed in the facility and not impeded to provide medical care to residents. All interviewed residents stated that nurses or other medical staff were never impeded by facility staff while providing medical care to them. Continue 9099C Regarding the allegation that Resident was not accorded privacy while in care, it was alleged that the resident was not provided privacy at the time of the nurse’s visit. Interviewed Administrator and staff denied the allegation. The administrator stated that they and their staff always provide privacy to resident’s visitors and medical professionals / nurses. Administrator stated when a family members or medical professionals / nurses entered residents room be able to close the door to protect residents privacy rights. Interviewed staff stated that they always provided privacy for residents. Visitors and residents call the staff when they need assistance. Interviewed residents stated that facility staff provided privacy to them. At the time of visit LPA observed that medical professional / PT ( Physical Therapist) was in the R2's room to provide medical care to resident, and staff provided privacy to resident and PT. Based on LPA observations, interviews conducted, and records review: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit Interview conducted, a copy of this report provided to Hiransha Keerthisinghe.the state’s words, verbatim · CDSS document, Mar 4, 2024 · control 28-AS-20220110123454

Type of visit: Required - 1 Year

On 1/09/24 at 8:21 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Prime Care Facility Home Inc. Upon arrival LPA was greeted by the Administrator Keerthisinghe Hiransha and explained the reason for the visit. This home is licensed to serve age range 60 and over. (6) non-ambulatory, of which 1 may be bedridden. Bedridden in room #4. Hospice waiver for 2. There were (5) residents in care during the time of the visit. The last emergency disaster/fire drill was conducted on 11/01/23. The Administrator Certificate expires on 5/12/2024 #6039969740. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (3) staff files, (5) resident files, medications, and medication administration records for (5) residents. This home contains 3 bedrooms, 1 bedroom with bathroom, 1 bathroom, living room/office, kitchen, dining room, and an attached garage. LPA toured the physical plant with the Administrator. and observed all (4) resident bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The two bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 105.0*F-111.0*F respectively which meet title 22 guidelines. The smoke detectors/carbon monoxide were battery operated, tested, and observed to be working properly. There were (1) fire extinguishers located in dining room fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. The sharps and toxins were locked and secured in kitchen cabinets. The pantry was well stocked with canned goods, pasta, cereals, and contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.) The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for client use. The garage contained a working washer and dryer, with cabinetry that contained bottled water, toiletries, personal care supplies, PPE supplies, food supplies, toxins and cleaning agents stored locked and inaccessible to the residents. The notifications and postings: California Labor Laws, Emergency Disaster Plan, personal rights, facility license, business license, medical emergency information, let-us-know licensing contact information, consumer grievance, support services, community resources and client activity schedule. Exit interview conducted with Administrator keerthisinghe Hiransha copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2024