Lola Senior Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six non-ambulatory residents; of which, one may be bedridden. The facility is full at the moment with six residents admitted. All residents were present during the visit. There’s a total of 6 bedrooms and 4 bathroom areas. There’s a living room space, a dining space, backyard, and a detached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in between 108.5 – 109.5 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked in a kitchen drawer across from the sink. Cleaning chemicals are stored below the sink in a locked cabinet. Food Service: A supply of perishable and non-perishable food supply that meet regulation requirements was observed. Client & Staff Files: Resident and staff files stored in locked filing cabinets near a dining table below the facility postings board. File Review: 3 of 6 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications and the first aid kit are stored in the locked filing cabinets near the dining table. Medication Review: 3 of 6 resident medications were reviewed during the visit. Medication is being administered as prescribed. No discrepancies were noted. Continued on LIC809C. Linens & Hygiene Supplies: Hygiene items were observed in the resident bathrooms locked below the sink and additional hygiene items were observed in the laundry room. Garage/Storage Area: The garage is used as a storage space for various supplies. Incontinent care supplies, oxygen tanks, a Hoyer lift, walkers, clothing, surgical mask, etc. An emergency supply of waters and sleeping bags were observed. Backyard/Exterior:. Clean and organized. Walkways are free of obstruction. A table and chairs were observed under a patio area. Bodies of Water: Swimming pool is surrounded by a self-latching fence that measured five feet high off the ground. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguishers were observed mounted in the kitchen and in the dining room behind the dining table. An emergency evacuation drill: An emergency evacuation drill was conducted March 15, 2026. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the main postings board above the locked filing cabinets where medications, and staff, and resident files are stored. Additional Comments: Licensing fees are current. Residents were observed and appeared healthy and well taken care of. The emergency disaster plan was reviewed; licensee was advised to look for shelter location in neighboring cities. Facility residents were unresponsive to LPA’s greetings, so interviews were not attempted. No deficiencies are being cited as a result of today’s visit. An exit interview conducted, and a copy of the report was providedthe state’s words, verbatim · CDSS document, Mar 24, 2026

Allegation investigated: Staff are not properly caring for resident's pressure injury resulting in it getting worse

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the complaint investigation into the allegation above. LPA Haley was greeted, granted entry and explained the reason for the visit to staff. Staff contacted Administrator (AD) Kevin Dinh who arrived and was present the remainder of the visit. During the investigation, interviews were conducted with staff, medical professionals and a resident. Regarding the allegation above, 3 of 4 individuals, including medical professionals provided information that contradict the complaint allegation. During the investigation it was discovered, Resident 1 (R1) has a pressure wound on the left buttock. R1 is currently under the care of their hospice provider and receives hygiene services from the hospice provider three times a week: Monday's, Wednesday's, and Friday's. Since the pressure ulcer re-opened, wound care services are now being provided twice a week by hospice. W1 confirmed the presence of a pressure sore on R1’s buttocks. W1 stated the wound was a stage 2 wound, and as of October 10, 2025, the wound was healing well. Continued on LIC9099C Unsubstantiated A review of the hospice documents reveals the redness on the left buttock opened, and classified as a stage 2 pressure ulcer. Hospice document review and interview confirmation reveal, facility staff were instructed on how to provided care for the resident’s pressure sore and reposition the resident to keep pressure off their butt. Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegation is deemed Unsubstantiated.the state’s words, verbatim · CDSS document, Oct 17, 2025 · control 22-AS-20251010083616

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six non-ambulatory residents; of which, one may be bedridden. As of today, the facility has five residents admitted to the facility. All of the residents were present during the visit, all residents were observed in their room during the visit, except one resident who was observed watching television. There’s a total of 6 bedrooms and 4 bathroom areas. There’s a living room space, a dining space and a detached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in between 105.2 – 106.5 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked in the a kitchen drawer. Cleaning chemicals are stored below the sink in a locked cabinet. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Client & Staff Files: Resident and staff files stored in locked filing cabinets near a dining table below the facility postings board. File Review: 3 of 5 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications and the first aid kit are stored in the locked filing cabinets near the dining table. Medication Review: 3 of 5 resident medications were reviewed during the visit. Discrepancies were noted and photos were taken. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in the resident bathrooms locked below the sink and additional hygiene items were observed in the laundry room. Garage Area: The garage is used as a storage space for various supplies. Incontinent care supplies, walkers, clothing, surgical mask and an additional water supply was observed. Backyard/Exterior:. Walkways are free of obstruction. A table and chairs were observed under a patio area. Bodies of Water: Swimming pool is surrounded by a self-latching fence that measured five feet high off the ground. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted in the kitchen and in the dining room near the locked medication, and locked staff and resident files. An emergency evacuation drill: An emergency evacuation drill was conducted September 10, 2025. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the main postings board above the locked filing cabinets where medications, and staff, and resident files are stored. Additional Comments: Licensing fees are current. Interviews with staff were conducted A resident interview was conducted. Facility contact information was reviewed, updated, and confirmed during the visit. Deficiencies are being cited as a result of today’s annual inspection. An exit interview conducted, and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 30, 2025

Allegation investigated: Facility did not provide proper care and supervision

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegation above. LPA Haley was greeted, granted entry and explained the reason for the visit upon entering the facility. During the visit LPA interviewed staff, collected and reviewed relevant documents, and toured the facility to make observations. Regarding the allegation above, 5 of 5 individuals interviewed confirmed the complaint allegation. According to S1, R1 was able to leave the facility and was found by the police and taken to the hospital. S1 was not aware R1 was missing until the morning of July 22, 2025, when hospital staff called the facility around 6:59am and asked if they were missing a resident. S2 says staff were unaware R1 left the facility. According to S2, the last time the caregiver observed R1 was around 7:00pm and then again around midnight. S2 says R1 was sleeping good, and then said R1 was probably just pretending to be sleep when S2 checked on the residents. According to S2, when they woke up sometime in the morning, the caregiver could not locate R1. According to S2, they checked all over the facility before calling S1 to inform them R1 was gone. Continued on LIC9099C Substantiated Document review revealed, R1 was found by the police around 2:00am on July 22, 2025, and taken to the hospital. R1 has a dementia diagnosis and is not allowed to leave the facility unassisted. Based on the evidence gathered through interview confirmation and document review, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22. An immediate civil penalty of $500 is being assessed. An exit interview was conducted, and a copy of this report, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 30, 2025 · control 22-AS-20250723144514

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 31, 2025

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This requirement was not met as evidenced by: Based on interview confirmation and document review, R1 was able to leave the facility unassisted in the middle of the night without staff being aware of the residents’ whereabouts, which poses an immediate threat to the residents health and safety.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Administrator Dinh stated he will provide an in-service training for all staff on elopement procedures, caregivers responsibilities, and provide a seven-day schedule for the caregiver who will be assigned to be on duty at night. Administrator Dinh will send a summary of the completed in-service training with a sign-in sheet. The summary breakdown will include the duration of the training and the topics covered during the in-service training. All documents will be emailed to LPA Haley by 4:00pm on the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jerome Haley conducted a case management visit regarding information discovered during the investigation into complaint control # 22-AS-20250723144514 During the complaint investigation mentioned above, LPA Haley received confirmation that, the facility did not report an elopement incident involving Resident 1 (R1). S1 reported the incident to an Assisted Living Waiver (ALW) personnel, but did not inform the department. S1 forwarded LPA Haley a copy of the incident report that was sent during the visit. LPA Haley checked the department’s SharePoint data base where incident reports are stored and there was no incident report for R1. As a result of today’s Case Management visit, a violation will be cited per California Code of Regulations Title 22. An exit interview was conducted and a copy of this report, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 30, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 5, 2025

87211 Reporting Requirements (a) Each licensee shall furnish...reports as the Department may require, including, but not limited to... (1) A written report shall be submitted to the licensing agency... within seven days of the occurrence of any of the events specified... below. This report shall include the resident’s name, age...disposition of the case. This requirement is not being met as evidenced by: Administrator Dinh confirmed no incident was sent to the Regional Office regarding R1’s elopement.the state’s words, verbatim · CDSS document, Jul 30, 2025

Plan of correction: Administrator Dinh will read and review the regulation section on reporting requirements and email LPA Haley a signed statement of acknowledgement and understanding by 4:00pm on the POC due date.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Jerome Haley arrived to complete the required one-year annual visit that was started May 15, 2024. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. A phone call was placed to Administrator Kevin Dino Dinh who arrived a short time later and was present for the visit. During the visit, LPA Haley completed the inspection tool, and conducted a brief tour of the backyard to observe the corrections that were made after the inspection on May 15, 2024. As a result of the annual inspection, a citation and a technical violation were issued. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Dinh.the state’s words, verbatim · CDSS document, Jun 6, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jerome Haley and conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Administrator (AD) Kevin Dinh who arrived a short time later and was present for the remainder of the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had the necessary elements and were in compliance with regulation guidelines. Hot water temperatures were measured in the range of 106.5 degrees Fahrenheit and 113.5 degrees Fahrenheit. In the kitchen, knives and sharp objects are kept locked in a drawer. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. Cleaning solutions are locked under the kitchen sink. The garage is cluttered and used to store miscellaneous facility items: matts, wheelchairs, toilet paper, oxygen tanks, etc. There were no clear walkways available in the garage. On the side and directly behind the garage, there is a large amount of clutter and debris that need to be disposed of. The backyard was organized, and free of clutter. There’s a shaded patio area with a table and chairs. The pool is surrounded by a self-closing and self-latching fence that meets regulation requirements. A fully charged fire extinguisher was observed mounted on the wall in the kitchen and in the dining room areas. There are locked filing cabinets in the dining room area used to store resident medication, staff, and resident files. A first aid kit with all the required elements is in a filing cabinet near the main entrance. Smoke carbon monoxide detectors tested operational. During the inspection, LPA Haley reviewed, resident medication, and conducted interviews with residents and staff. Continued on LIC809C Due to time constraints, the annual inspection will be ended and will be continued at a later time. Deficiencies and Technical Violations observed and photographed during the tour of the physical plant, medication review, and discovered during interviews will be cited at the conclusion of the annual inspection. An exit interview was conducted, and a copy of this report was provided to Administrator Kevin Dino Dinhthe state’s words, verbatim · CDSS document, May 15, 2024