All in Carehome

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sanjay Vaid conducted an unannounced required annual inspection visit and was greeted by care giver Jerome Unica. LPA Vaid explained the purpose of the visit. The facility is located on a residential street and is a single-story dwelling. Administrator was notified and arrived shortly after to assist with the visit. LPA utilized the Compliance and Regulatory Enforcement tools for the visit today and observed the following: Operational Requirements: The fire clearance is approved for six (6) non-ambulatory of which one (1) may be bedridden. This facility may retain no more than three (3) hospice residents. There were zero (0) residents under hospice care during inspection. Residents Rights-Information: LPA Vaid observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Vaid observed facility land line. Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Vaid observed carbon monoxide detectors and smoke alarms in hallways and are operational. LPA Vaid inspected four (4) resident rooms, two shared and two single occupancy. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Vaid observed grab bars near toilets and inside showers. LPA Vaid observed no-slip mat in showers. Food Service: LPA Vaid observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F, and refrigerators with maximum temperature of 40-degree F. CONTINUED ON 809C.................... Planned Activities: LPA Vaid observed staff assisting residents with seated exercises, coloring and crossword puzzles, and media. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on quarterly, last drill was conducted 05/2026. LPA Vaid observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Vaid observed emergency food supply located in kitchen cabinets. Insurance liability expires 10/29/2026. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication rooms and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Staffing: Administrator Certificate for Shelly Yamashiro expires 10/05/2027. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Vaid observed required annual training, CPR and First Aid for five (5) personnel records reviewed. LPA Vaid observed TB testing results, Health screening, fingerprint clearance and job application for five (5) personnel records reviewed. Resident Records/Incident Reports: LPA reviewed resident files for six (6) residents in care. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Residents with Special Needs: No large bodies of water were observed LPA Vaid observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Vaid observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. No deficiencies were observed during visit. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 13, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced continued Annual Inspection visit on 09/19/25 at approximately 9:10am. LPA was met by Caregiver Jerome Unica and explained the reason for the return visit. Administrator Shelly Yamashiro and Caregiver/Designated Administrator Rathany Suy arrived shortly after. The facility is licensed to serve clients of age 18 to 59 years old and has a fire clearance approved for six (6) non-ambulatory of which one (1) may be bedridden and approved hospice waiver for three (3) clients. There were one (1) resident under hospice care. During today's continued annual visit, LPA Madyun observed the following: Bathrooms: LPA retested bathrooms after water adjustment and temperature measured at 112.2-112.9 degrees Fahrenheit within the range of 105-120 degrees Fahrenheit. Kitchen: LPA retested kitchen after water adjustment and temperature measured at 111.2 degrees Fahrenheit within the range of 105-120 degrees Fahrenheit. Staffing/Personnel Files: LPA completed staff interviews and files. Client Records/Centrally Stored Medications: LPA observed six (6) of six (6) client files and reviewed the additional four (4) of six (6) clients medications and logs. Inspection tool completed. No deficiencies are being cited today. Exit interview conducted with Shelly Yamashiro and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit on 09/12/25 using the CARE Inspection tool. LPA was met by Staff #2 Jerome Unica and Staff #3 Gener Gutierrez and explained the purpose of the visit. S2 assisted in the tour of the facility and Administrator Rathay Suy arrived later during the facility tour. The facility is licensed to serve clients of age 18 to 59 years old clients and has a fire clearance approved for six (6) non-ambulatory of which one (1) may be bedridden and approved hospice waiver for three (3) clients. There were one (1) resident under hospice care.. A tour of the single-story facility began at approximately 9:10am that included residents’ rooms: one (1) private staff bedroom, four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, backyard, garage/laundry room/storage space. All residents’ bedrooms have the required furniture for privacy, comfort, and safety. Additional bedding supplies and grooming supplies were observed in the hallway cabinets securely locked. Bedrooms #4 had an exit door. Bathrooms were observed clean and in good repair. Each is in working condition, showers were observed with grab bars and skid mats aside the wall. Water temperature was tested in each bathroom sinks measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F. LPA observed the Infection Control Plan revised 06/26/25 and Emergency Disaster Plan revised 06/26/25. Last documented emergency drill conducted on 06/26/25. First Aid kit observed and (2) Fire Extinguishers were observed and last checked on 06/13/25. Carbon monoxide detector, smoke detectors, and auditory signal systems were in working order located throughout facility. LPA Madyun observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Madyun observed the emergency food supply in kitchen cabinet. LIC 809C for continuation of report. LPA observed the front and backyard to be clean and well maintained without any hazards. Due to windy weather conditions the provided shade covering was destroyed. The kitchen is in good repair, dishes and utensils were observed, the cabinets are used to store items for cooking. Refrigerators were observed clean and in good repair. Food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. Water temperature was tested in the kitchen sink measuring 125.0 degrees F - 125.2 degrees F., which is not within the required 105-120 degrees F. The Laundry area was observed in the garage with locking cabinets for items that are inaccessible to clients. Licensing posters, Let us Know (PUB 745) and clients' personal rights were observed on a board in the kitchen/dining area. No large bodies of water were observed LPA Madyun observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Madyun observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. The medications are centrally stored in the medication cabinet securely locked and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. Resident files are maintained at the facility. LPA reviewed two (2) of six (6) clients medication logs. Due to time constraint LPA will return a later date and time for a continuation visit and conduct client interviews and review files and medication logs. Administrator Certificate for Shelly Yamashiro #7014120740 expires 10/05/27. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Staff files are maintained at the facility. LPA Madyun observed required annual training, CPR and First Aid for seven (7) out of the seven (7) personnel records reviewed. LPA Madyun observed TB testing results, Health screening, fingerprint clearance and job application for seven (7) out of the seven (7) personnel records reviewed. Due to time constraint LPA will return a later date and time for a continuation visit and conduct staff interviews. The following deficiency were cited according to The State of California Regulatory Codes, Title 22, Div. 6, Chapter 1(refer to Lic 809D). Exit interview conducted with Shelly Yamashiro and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 12, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by care giver Carlo Encarnacion. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single-story dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. LPA Ramirez observed staff assisting residents with seated exercises, coloring and crossword puzzles. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 06/13/2024 and 03/29/2024. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in kitchen cabinets. See 809-C Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication rooms and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. Staffing: Administrator Certificate for Shelly Yamashiro expires 10/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory of which one (1) may be bedridden. This facility may retain no more than three (3) hospice residents. There were zero (0) residents under hospice care during inspection. Resident Records/Incident Reports: LPA reviewed resident files for six (6) residents in care. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during visit. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 5, 2024

Allegation investigated: Staff left the residents unattended while in care

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 3/X15/2024 to deliver findings. Initial complaint investigation was conducted on 03/07/2024 by LPA Ramirez and needs further investigation was documented. LPA Ramirez was met by Gloria Estrobo and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident Roster (LIC 9020), Staff Roster (LIC 500), Staff#1 - 3 interviews(S1 – S3), interview of Witness#1-2 (W1-W2) copy of Staff#2-3 (S2-S3) Personnel Record (LIC 501), Attempted interview of Resident#1-6 (R1-R6), Resident# 1-6 (R1- R6) review of resident records, copies of Resident#1-5 Physician’s Report, and physical plant tour. See 9099-C for continuation. Unsubstantiated The investigation revealed the following. Regarding Allegation: Staff left the residents unattended while in care- It is alleged staff left residents unattended on 2/21/24, around 5:30pm. Interview with W1 revealed on 2/21/24, around 5:30 pm, W1 made several attempts by ringing the facility doorbell and knocking on facility front door, to gain entry into the facility. W1 looked through the facility window and could see R1 sitting in their wheelchair and sitting at the kitchen table area. W1 revealed staff were not seen nearby after making several attempts to gain entry into the facility. W1 stated eventually an unknown young male (W2) answered the door and allowed W1 entry into the facility. W1 revealed they did not see any known staff in the facility for approximately 15 minutes after their arrival. Three (3) out of the three (3) staff interviewed deny this allegation. W2 denied this allegation. W2 stated staff#2 (S2) was in the facility garage area, tending to the laundry while W2 answered the door. W2 revealed all residents in care were in their rooms when W1 was allowed entry into the facility. It was revealed through records review and interviews that W2 is a minor child of S3. W2 revealed to LPA Ramirez that W2 was waiting for S3 to return to the facility but that S2 was in the facility garage when W1 arrived. Due to cognitive impairments, R1-R5 could not be interviewed. R6 no longer resides at the facility and was unable to be interviewed. LPA Ramirez did not observe video surveillance in common areas of the facility. According to Administrator Yamashiro, staff do not have timecards to clock in and out of their shifts. Although the allegation 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. No deficiency is being cited today. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 15, 2024 · control 28-AS-20240227160538

Allegation investigated: Staff did not ensure that a hazardous item was made inaccessible to resident. Staff did not maintain the facility in clean and sanitary condition.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 03/07/2024 regarding the above allegations. LPA Ramirez was met by Caregivers Rosalyne Obedoza and Edwin Uy and explained the purpose of the visit. Administrator Shelly Yamashiro arrived shortly after to assist with tour. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident Roster (LIC 9020), Staff Roster (LIC 500), Staff#1 - 3 interviews(S1 – S3), copy of Staff#2-3 (S2-S3) Personnel Record (LIC 501), Attempted interview of Resident#1-6 (R1-R6), Resident# 1-6 (R1- R6) review of resident records, copies of Resident#1-5 Physician’s Report, and physical plant tour. SEE 9099-C for continuation. Substantiated The investigation revealed the following. Regarding Allegation(s): Staff did not ensure that a hazardous item was made inaccessible to resident- It is alleged staff allow hazardous items to become accessible to residents in care. Three (3) out of the three (3) staff interviewed deny this allegation. At 8:52 am, LPA Ramirez toured shred bathroom #1. LPA Ramirez observed a can of Ajax powder bleach cleaner, sitting on top of bathroom cabinet. At 9:10 am. LPA Ramirez toured private bathroom#2 located in resident bedroom#3. LPA Ramirez observed a spray bottle of Clorox Bleach Germicidal Cleaner in bathroom shower. Four (4) out of five (5) residents in the home suffer from cognitive impairments. LPA Ramirez will issue deficiency based on observations. Based on observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. Staff did not maintain the facility in clean and sanitary condition- It is alleged the facility has mold in a bathroom and is dirty. Three (3) out of the three (3) staff interviewed deny this allegation. During tour of private bathroom#2 located in bedroom#3, LPA Ramirez observed blackish spots/and grime around the corner of the bathroom window, behind toilet and near toilet wall, and in between some of the tiles of the shower. LPA Ramirez will issue deficiency based on observations. Based on observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. Deficiencies are being cited today. A copy of this report, 9099-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 28-AS-20240227160538

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Mar 8, 2024

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidence by:the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Staff removed cleaning products and placed in secure location. **This will clear 24hr POC** Licensee will retrain staff on above regulation by 3/21/24. Proof of re-training must be sent by 3/21/24. LPA Ramirez observed cleaning products to be accessible to residents in care during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 8, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: LPA Ramirez observed blaskish spots and stains in bathroom#3 shower, near toilet wall and around window frame.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will clean area and send picture proof to LPA by 03/21/2024.

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

CASE MANAGEMENT FINDINGS: LPA Ramirez conducted case management deficiencies visit on 03/07/24, stemming from initial complaint investigation on 03/07/2024. LPA Ramirez and Administrator Shelly Yamashiro toured facility garage together. LPA Ramirez observed a cloth room divider near corner of garage, that was sectioning off an area of the garage. LPA Ramirez observed a bed with linen, several shoes, and various articles of clothing in bags and boxes. As of 3/7/2024, facility sketch does not indicate garage area is for live-in staff or a staff breakroom. According to Administrator Yamashiro, staff do not live in this area but they rest and may sleep in this area. During annual inspection on 09/21/2023, LPA Maldonado observed a makeshift room for live in staff in the garage. LPA Maldonado requested licensee obtain city permit for room built in garage or demolish room is not permitted by city. Plan of correction (POC) was due by 09/29/2023 and was not cleared. LPA Ramirez will issue deficiency based on observations and records review. Licensee will not use garage area for purposes of live in staff to dwell in garage unless licensee obtains a permit from city or licensee will demolish makeshift room area in garage. Deficiency being cited today: 87305(a) Alterations to Existing Building or New Facilities- (a)Prior to construction or alterations, all facilities shall obtain a building permit. Exit interview was conducted and a copy of this report and appeals rights was provided.the state’s words, verbatim · CDSS document, Mar 7, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Mar 21, 2024

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidence by: LPA Ramirez observed a cloth room divider near corner of garage, that was sectioning off an area of the garage. LPA Ramirez observed a bed with linen, several shoes, and various articles of clothing in bags and boxes.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will obtain proper city permits for the room built inside the garage, currently used for live-in staff, or demolish the room if not permitted by the city. Proof to be submitted to LPA via email by POC due date. Licensee will submit picture proof by due date of demolished room if unable to obtain permit.

Type of visit: POC

Licensing Program Analyst (LPA) Mora conducted an unannounced plan of correction (POC) visit to follow up on deficiencies noted on 10/26/23. LPA met with Edwin Uy (Caregiver) and explained the reason for the visit. On 10/26/23, LPA Mora conducted a complaint investigation visit and cited the following deficiencies: 87305(a) Alterations to Existing Building or New Facilities and 87303(a) Maintenance and Operation. On 10/26/23, LPA observed an unpermitted room in the facility's garage and was deemed a fire hazard by a City of La Verne Building Inspector and Code Compliance Officer. During today's visit, LPA observed that the unpermitted room has been demolished. Exit interview was conducted with Edwin Uy (Caregiver) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 28, 2023