Ayanna Home Care

Type of visit: Office

An informal Conference was conducted today in the Monterey Park Regional Office. The purpose of this informal conference meeting is to discuss the large number of citations the facility has received along with additional concerns that were observed. Present in the meeting is Licensing Program Manager David Sicairos, Licensing Program Analyst Christian Gutierrez, along with facility Administrator Elba Rodriguez. The informal Conference process was explained during this meeting. Issues Discussed during the meeting: High number of annual citations. Annual visit 09/05/2023: Eleven B citations, and three A citations. Citations cleared. (no staff files at time of visit) Annual visit 09/12/2024: One B citation issued. Citations cleared. (no staff files at time of visit) Annual visit 08/28/2025: Three A citations, two B citations. One cleared. ($500 civil penalties issued – Care of Bedridden Residents) Annual Continuation 09/07/2025: Two B citations. One cleared Case management POC visit 09/07/2025 ($900 civil penalty issued – Failure to correct POC – Care of Bedridden Residents) Case management 12/19/2025 ($500 civil penalties issued – Criminal Record Clearance- $900) Annual visit 07/23/2026: Two A citations, ten B citations 6 cleared. Dementia Residents without a Dementia Plan on file: Received Designation of Facility Responsibility (LIC308) Discussed TSP Services The facility has stated they will do the following to achieve continued and substantial compliance: · Administrator explained that she will submit POCs for all uncleared deficiencies by 09/04/2026 · Administrator confirmed Administrator is interested in TSP services. Regional office will submit TSP referral. Failure to correct Plans of Correction (POCs) or failure to pay issued civil penalties could result in possible administrative action. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies issued following the meeting. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with caregiver Elizabeth Rodriguez and explained reason for visit. Administrator Elba Rodriguez was notified by telephone and stated she was attending a personal matter. Facility is licensed to serve six (6) non-ambulatory residents age 60 and over. The facility may retain three (3) hospice residents. The facility is in a residential area. A tour of the facility included the living room, kitchen with dining area, 4 resident bedrooms, 2 bathrooms, attached garage, and outside shaded area for residents. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. LPA observed one resident with full bed rails and no hospice plan available. Room #2 had a mattress and bed rails on floor. The Smoke /carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has three (3) fire extinguishers that were serviced on 07/21/2026. Cleaning supplies and toxic substances were observed to be accessible under kitchen sink at time of visit. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents outside. Passageways and exits are free of obstruction. LPA was unable to review Administrator, staff/staff training, and resident files due to staff having no access to documents and Administrator being away and not having an authorized designee. Facility did not have dementia plan of operation available at time of visit along with required Liability Insurance. LPA requested a copy of infection control plan, emergency disaster plan, and emergency drills conducted at facility. LPA could not conduct a medication check due to staff not having a list of prescribed medication from physician with dosages at time of visit. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Elizabeth Rodriguez.the state’s words, verbatim · CDSS document, Jul 23, 2026

We haven’t transcribed this report yet. The complete document is on the state’s site.

Allegation investigated: facility is not meeting resident’s needs.

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Caregiver Mitchell Castaneda who assisted with today’s visit. Administrator Elba Rodriguez was notified by telephone. The investigation consisted of the following: During the initial visit conducted on 11/20/2025, LPA obtained copies of the following documents: Staff roster, resident roster, R1 physician report LIC 602, resident appraisal LIC 603A, identification and emergency information LIC 601, medical record progress notes, after visit summary notes, and requested plan of operation. LPA Gutierrez interviewed Administrator and did a tour of home LPA observed a sufficient supply of food and observed the residents to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns. On today’s visit LPA interviewed staff 1-staff 2 (S1-S2), residents 2 -residents 5 (R2-R6) and delivered findings. See LIC 9099C Unsubstantiated In regard to the allegation “facility is not meeting resident’s needs”, it is alleged that R1 may need a higher level of care than what the facility could provide. During interviews with Administrator and staff three (3) out of three (3) stated that they believed that they could care for R1. Administrator stated that R1 was at the facility for less than three weeks in total and during that time enough care was provided. LPA was able to obtain documents stating that prior to admission to facility R1 was in VA hospital and did not come to facility till 10/17/2025. Facility obtained a LIC 602 physicians report that did not indicate any prohibited health conditions, on 10/22/2025 family took R1 to a doctor’s appointment for a checkup and no health concerns were reported, on 10/30/2025 family took R1 to emergency room where he stayed for two weeks, on 11/17/2025 R1 went back to hospital and did not return back to facility due to being transferred to a skilled nursing home. During interviews with residents four (4) out of five (5) residents stated facility staff take care of them. R4 stated that it is wonderful here. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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. An exit interview was conducted, and a copy of this report was given to Mitchell Castaneda. _the state’s words, verbatim · CDSS document, Dec 19, 2025 · control 28-AS-20251114111409

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christian Gutierrez generated this Case Management - Deficiencies report in conjunction with complaint control 28-AS-20251114111409 pertaining to observations during record review. The purpose of the report was explained to staff. During complaint investigation, LPA Gutierrez discovered that Administrator failed to report R1’s hospitalization to Community Care Licensing, facility does not have a dementia care plan in the facility Plan of Operation and S3 did not have a criminal background. Based on observation, a citation is being issued. See LIC 809D. An exit interview was conducted, and a copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Dec 19, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jan 2, 2026

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Based on record review Admiistrator did not report to CCLD when resident was in hospital which poses a potential risk to the persons safety, health, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Administrator will go over section 87211 reporting requirements and develop a plan to insure incidents are reported to CCLD and send LPA plan.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a) · Plan of correction due date: Jan 2, 2026

87208 Plan of Operation (a)The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: Based on record review facility does not have a dementia care plan and currently has three residets with dementia which poses a potential risk to the persons safety, health, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Administrator will send LPA Plan of Operation with an addendum to include Dementia to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 20, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department This requirement was not met as evidenced by: S3 did not have record of criminal clearance . This poses an immediate risk to the health, safety, or personal rights of persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Staff 3 clocked out and facility will ensure S3 is finger prited and cleared before returning to work.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Christian Gutierrez conducted an annual continuation visit. Upon arriving at the facility, LPA met with Administrator Elba Rodriguez who assisted with the visit. On 08/28/2025 LPA conducted an initial visit. During today's visit LPA Gutierrez reviewed the following CARE inspection tool domains: Staffing, Personnel Records/Staff Training, resident rights, resident records, health-related services, and incidental medical services. Two (2) staff files were reviewed and included criminal clearance record, and health screening with TB. Five (5) resident files were reviewed and included physician’s reports and appraisal needs and service plan. Fire/earthquake drills have not been conducted. The medications are centrally stored and locked in a cabinet in kitchen. LPA reviewed medications for residents three (3) residents and found missing medications for two residents. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Elba Rodriguezthe state’s words, verbatim · CDSS document, Sep 7, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Christian Gutierrez conducted a plan of correction (POC) visit and met with Administrator Elba Rodriguez and explained the reason for the visit. On 08/28/2025 LPA was conducting an annual inspection cited for the following deficiency’s: 87606(c) Care of Bedridden Residents (c) To accept or retain a person who is bedridden, other than for a temporary illness or recovery from surgery, a licensee shall obtain and maintain an appropriate fire clearance as specified in Section 87202, Fire Clearance. 87412(f) Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: POC were due on 08/29/2025, and 09/04/2025 and as of today 09/07/2025 the facility has not cleared POC’s. LPA will be assessing civil penalties a copy of report and 421FC was given to Administrator Elba Rodriguezthe state’s words, verbatim · CDSS document, Sep 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Elba Rodriguez and explained reason for visit. Facility is licensed to serve six (6) non-ambulatory residents age 60 and over. The facility may retain three (3) hospice residents. During record review it was revealed that two (2) residents are bedridden. Facility will contact fire department. The facility is in a residential area. A tour of the facility included the living room, kitchen with dining area, 4 resident bedrooms, 2 bathrooms, attached garage, and outside shaded area for residents. LPA toured the facility and observed the following: Each resident bedroom has the required furniture and bedding. LPA observed four residents with bed rails and no physicians’ orders. The Smoke /carbon monoxide detectors were observed throughout the facility and are properly operating. The facility has three (3) fully charged fire extinguishers throughout facility. Cleaning supplies and toxic substances were observed to be inaccessible. During the tour LPA observed a large knife in drying rack on kitchen counter accessible to residents. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Facility was observed to have sufficient supply of 2 days perishable & 7 days non-perishable foods. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents outside. Passageways and exits are free of obstruction. LPA reviewed two staff files that both were missing required training. Administrator file was not available during visit. ***Due to time constraints, LPA was not able to complete the annual inspection for this facility. LPA will do a continuation of this inspection. *** Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Elba Rodriguezthe state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual continuation visit at the facility using the CARE Tool. LPA Mora met with the Administrator Elba Rodriguez and explained the reason for the visit. During this visit, LPA Mora conducted another tour of the facility, interviewed 2 staff and 2 residents, reviewed the Emergency Disaster Plan, and delivered the findings for the annual visits conducted on 08/27/2024 and today. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was a deficiency observed during these annual visits (Refer to LIC 809-D). Exit interview held and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 12, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with the Administrator Elba Rodriguez and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents only over the age of 60 and approved for 3 hospice residents. The facility is operating within the scope of its license. A tour of the single-story facility included: 4 resident bedrooms, 2 bathrooms, living room, kitchen, open area, 2 caregiver rooms, backyard, and attached garage. LPA and Elba Rodriguez toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen and garage. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in all 2 bathrooms and measured at 118.3 degrees F and 116.6 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. A carbon monoxide was observed in the kitchen and it is properly operating. Fire extinguishers were observed in the kitchen, living room, and hallway which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps and cleaning supplies are kept locked in a kitchen closet. First Aid kit was fully stocked with current manual and it is kept in the medication cabinet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. Residents medication are centrally stored in a locked kitchen cabinet. LPA reviewed staff and resident files. LPA reviewed residents medication. Due to time constraint, the LPA will return at different date to complete the annual inspection. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 27, 2024