Argonaut Care Home

Type of visit: Required - 1 Year

Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 09/30/26. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with the Designated Facility Administrator. LPA learned that that Administrator of record, Shadae James did not have an active Administrator certificate. This deficiency was cited on the LIC 809D page. LPA met with Designee, Andeta Smart. LPA had emailed a list of documents (below) to be collected during this visit. These documents included: LIC 500: Personnel Report; please update and remove any staff no longer employed and include all new hires in Guardian. To associate someone to your facility, submit your fingerprint transfer to sactranfserrequest@dss.ca.gov. A copy of your Resident/Client Roster LIC 308: Designation of Administrative Responsibility LIC 309: (for any LLC or Corp) if applicable LIC 402: Surety Bond, if applicable LIC 610E: Emergency Disaster Plan Copy of Liability Insurance An updated lease agreement, if applicable. An updated Facility Sketch LPA compared the LIC 500 to the Guardian roster to ensure that all staff had the required background clearances. All were in compliance at the time of this inspection. The LPA inspected the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. LPA inspected 4 resident rooms. All had the required furniture, furnishings and lighting to be in compliance at the present time. LPA inspected a total of 2 resident bathrooms. Each contained soap, paper towels, trash cans with lids and grab bars as required. Showers had non-skid surfaces for safety purposes. The 2 fire extinguishers (1 in the kitchen, 1 in the garage) were last serviced on 07/15/26 by Sierra Foothill Service Fire Extinguisher Company and were in compliance at the time of inspection. The LPA observed medications were stored in a locked closet near the primary resident bathroom and inaccessible to residents in care. LPA observed bins for each of the current residents along with an extra bin that contained pre-poured weekly pill organizers for 3 of the 5 residents in care. This deficiency has been cited on the LIC 809D page. LPA reviewed storage, dosing, and destruction procedures with Designee. LPA informed the Designee regarding the requirement for over-the-counter medications like Tylenol to have prescriptions on file. A review of the First Aid kit by the LPA found it to be complete and in compliance. The exterior of the building was inspected by the LPA. The yard accessible to the residents in care was well maintained and in good repair. There were sitting areas in shaded locations for residents and their guests to enjoy. In a separate locked area, there was an in-ground pool that was covered, completely fenced in, locked and inaccessible to residents in care. LPA observed that two of the sliding door screens off the back of the house were in need of repair as well as one rear window and one window on the left side of the house. LPA also observed that there were sheds built onto the side of the left side of the home that had doors that were falling off. The gutters to those sheds were overflowing with moss and debris. This deficiency has been cited on the LIC 809D. LPA conducted a review of 2 resident files. LPA provided consulting regarding the difference between an LIC 602 and an LIC 602A. LPA also reviewed 2 staff files. Both were missing documentation regarding training. This deficiency was cited on the LIC 809D page. LPA reviewed the LIC 500 schedule of staffing and observed that the Administrator listed was scheduled to work alone from 7:00 AM - 7:00 PM on Sundays. Administrators are required to staff adequately so that may be present at the facility to supervise staff and manage the day to day operations during regular business hours. This deficiency was cited on the LIC 809D page. According to the California Code of Regulations, Title 22, no other deficiencies were cited during today's visit, a copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with the Designee.the state’s words, verbatim · CDSS document, Sep 30, 2026

The state marks this report as 11 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Collateral

A collateral visit at this facility on 03-12-2025 was conducted by Licensing Program Analyst, Arvin Villanueva (LPA). LPA initially met with staff on duty, Candies Campbell, and stated the purpose of the visit. The administrator, Shadae James, was notified and is unable to be present at this time. Present during this visit were five residents in care with two staff on duty. The purpose of this visit is to deliver the complaint investigation findings for Complaint Control #27-AS-20250819084651 and Complaint Control 27-AS-20250910155206. These complaints are unrelated to this facility. Findings were delivered via phone with the administrator. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 12, 2026

Type of visit: Office

Announced office visit was conducted, via Microsoft Teams, on 2/3/2026 by the following participants: Stephen Richardson, Licensing Program Manager (LPM); Arvin Villanueva, Licensing Program Analyst (LPA); Chukwudi “Patrick” Ikiseh, Facility Co-Licensee. Note that Co-Licensee, Sylvester Okoro, was invited to this meeting but did not attend. The purpose of this office meeting was to discuss the complaint investigation regarding Complaint #27-AS-20250430095638. The following information was obtained: Facility Oversight: Patrick stated he is overseeing the operations of the facility. Patrick confirmed that Co-Licensee Sylvester Okoro is not physically involved in the facility’s operations. Staff Roles: Patrick confirmed that Staff #1 (S1) serves as the supervisor and communicates facility needs and updates to Patrick. Staff Performance: Patrick stated that Staff #2 (S2) was considered a good caregiver but noted concerns regarding S2’s alertness and follow-through. Patrick reported there were no documented complaints about S2 prior to R1’s incident. Alarm Procedures: Patrick stated that door alarms are required to remain on throughout the day and staff are not permitted to turn them off. Patrick indicated this expectation was verbally communicated to staff. Prior to R1’s incident, Patrick reported no information suggesting alarms were turned off while staff were on duty. Incident Details: Patrick stated that although S2 reported the alarm was on and did not hear it, Patrick expressed doubt that the alarm was active during R1’s incident. Corrective Actions: Following the incident, Patrick installed a louder door alarm and cameras to monitor overnight activity. Documentation: Patrick stated he will provide requested documents by Friday, 02/06/2026, and will submit a new administrator appointment letter for the facility. No deficiencies were cited during this visit. An exit interview was held with all parties. A copy of this report was emailed to Patrick to be signed and returned a signed copy to the Department.the state’s words, verbatim · CDSS document, Feb 3, 2026

Type of visit: Case Management - Incident

On 9/18/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to correct a report that had been mistakenly entered for a different facility. During a previous unannounced visit to this facility on 8/19/2025, the report had been submitted under Facility #032701225, which has a similar name. LPA met with the facility supervisor, Renae Earl (S2), and clarified the purpose of the visit. *** The report below was incorrectly entered to a different facility *** Licensing Program Analyst (LPA) Arvin Villanueva arrived at the facility unannounced to follow up on a death of a resident in care. LPA met with staff on duty, Lacreisha Wilson (S1) and explained the reason for the visit. The Licensee, Chukwudi (Patrick) Ikiseh, was notified and gave permission to S1 to sign this report. Initial observation: Upon arrival, LPA observed (S1) leaving the facility to go to another facility, about two houses away. LPA rang the door bell 3 times before a visitor (V1) answered the door. V1 stated they cannot let LPA come in and stated that the staff on duty had stepped outside for phone call. After 2 to 3 minutes later, S1 arrived back to the facility and LPA was able to enter. LPA observed 4 residents in the living room with V1 visiting a family member. Per interview with S1, S1 was instructed by their supervisor (S2) to go to the other facility down the street to open a door for the delivery person. S1 confirmed that the visitor is not a staff and that no other staff is on duty during this visit. LPA spoke with Licensee, Chukwudi (Patrick) Ikiseh, to inform him of the lack of staff upon arrival. Per Licensee, he was observing the residents through the camera in the living room. {1} Regarding the death incident: On December 2, 2024, the facility notified the Department of the death of Resident 1 (R1). Upon notification of the death, the LPA requested and obtained copies of resident and staff records, including but not limited to staff schedule, resident roster, Personnel Report, Physician reports and Needs and Services Plans for residents. In addition to the records already noted, the Department obtained medical records from the acute hospital, interviewed staff, reviewed notes from doctor visits for Resident 1 (R1), and reviewed medical records from the skilled nursing facility R1 was admitted. Per medical records, it was noted that R1 had a catheter in place. R1 was responsible for the care of the catheter including draining. R1 was independent with most activities of daily living only receiving staff assistance with showers and catheter bag sanitization. R1 was routinely seen by their urologist who did not note any concerns regarding the catheter. Per staff interviews, blood was observed on 11/4/2024 in R1’s catheter bag. Paramedics were called to assess R1, but R1 refused medical treatment. Blood was observed in the catheter bag again on 11/15/2024 and paramedics called. R1 was treated at the hospital and died on 11/20/24. The Department also reviewed local fire department records to confirm emergency services were called on 11/4/24 and 11/15/2024. It was unclear if the death of R1 was due to neglect of the facility or R1’s own negligence, therefore the allegation was unsubstantiated. *** end of report *** Note that deficiency was cited on 8/19/2025 and facility submitted the plan of corrections. S2 needed to leave during the visit and gave permission to S1 to sign this report. Exit interview was conducted and a copy of this report was provided. {2}the state’s words, verbatim · CDSS document, Sep 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Aug 19, 2025

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the regulation cited above. Upon arrival at the facility, there were no qualified staff members, except for one visitor who was not authorized to provide supervision to residents in care. This poses an immediate health, safety and personal risks to persons in care.the state’s words, verbatim · CDSS document, Sep 18, 2025

Plan of correction: *note: this was cited on 8/19/25 and plan of corrections has been completed. Per discussion, Licensee will read the cited regulation and submit a letter of understanding; Licensee to submit letter to the Department by POC due date. Licensee shall ensure a qualified staff is present at the facility at all times to provide supervision to resident in care.

Allegation investigated: Due to neglect or lack of supervision, resident sustained multiple injuries resulting in hospitalization. Lack of supervision resulted in resident eloping from facility.

On 9/9/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a follow-up complaint visit and deliver findings regarding the allegations noted above. LPA met with staff on duty, Licreisha Wilson (S1), and explained the purpose of the visit. The facility supervisor, Renae Earl (S2) was notified and gave permission to S1 to sign this report. Present during today’s visit were 5 residents with 1 staff on duty (S1). Allegation - Due to neglect or lack of supervision, resident sustained multiple injuries resulting in hospitalization: The investigation into this allegation consisted of interviews and record reviews. On 4/30/2025, resident (R1) was found outside in the roadway injured and bleeding after leaving the facility unsupervised. Witness (W1) statement and police reports confirmed the facility’s front door was open when they arrived at the facility and staff on duty, S1, admitted to be “very tired” and had not checked on residents. Interview with Police Officer (W2) confirmed S1 was asleep behind a locked garage door and had to wake S1. {9099-1} Substantiated Facility Supervisor (S2) and Administrator, Chukwudi “Patrick” Ikiseh (S3), both acknowledged that it was facility policy for the front door alarm to remain activated at all times, but it had not been turned on the night of the incident. S2 and S3 also admitted that the alarm was old, and staff sometimes forgot to use it, leaving the facility unsecure. Review of R1’s medical records confirmed that as a result of leaving the facility unsupervised, R1 sustained multiple serious injuries, including fractures to the cervical spine, nasal bone, nasal septum, and orbital roof, as well as facial bruising, resulting in hospitalization. Medical records and death certificate record further confirmed that R1’s injuries, combined with advanced dementia and lack of food and fluid intake, contributed to R1’s death on 5/8/2025. The evidence shows the facility did not ensure to provide proper supervision and security, which directly led to R1’s injuries, resulting in hospitalization and eventual death. Therefore, the allegation is SUBSTANTIATED. **************************************************************************************************************************** Allegation - Lack of supervision resulted in resident eloping from facility: The investigation into this allegation consisted of interviews and record reviews. On 4/30/2025, a resident (R1) was found outside in the roadway after leaving the facility unsupervised. Witness (W1) and police reports confirmed the facility’s front door was open when they arrived at the facility, and staff on duty, S1, admitted she had not checked on residents because she was “very tired.” Responding Police Officer (W2) confirmed S1 was asleep behind a locked garage door when W2 entered the facility. Supervisor (S2) and Administrator Chukwudi “Patrick” Ikiseh (S3) both acknowledged that facility protocol required the front door alarm to be turned on at all times, but it was not activated the night of the incident. S2 and S3 also admitted there was no system in place to document when the alarm was turned on or off, and staff sometimes forgot to use it. Interview with S3, suspected that R1 likely spent 30 to 45 minutes outside unsupervised before being found. Because the alarm was not activated and staff did not provide the expected supervision, R1 was able to leave the facility unnoticed, resulting in R1 being found injured in the street. The evidence demonstrates that the facility did not follow its own safety protocols, directly leading to R1’s elopement. Therefore, the allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. {9099-2} Deficiencies are being cited from the California Code of Regulations (CCR) and/or the Health and Safety Code. Immediate Civil Penalty is being assessed in the amount of $1000.00. At this time enhanced civil penalty assessments are under review and additional civil penalties may be assessed pursuant to Health and Safety Code 1569.49. An exit interview was conducted with S2 over the phone and a plan of corrections and appeal process were discussed. A copy of this report and appeal rights were provided. {9099-3}the state’s words, verbatim · CDSS document, Sep 9, 2025 · control 27-AS-20250430095638

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(e) · Plan of correction due date: Sep 10, 2025

Basic Service Requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement is not met as evidenced by: Based on interviews and record reviews, R1 left the facility unsupervised and sustained multiple injuries resulting in hospitalization. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: Per discussion, S3 stated facility made multiple changes including installing camera at the front door, night staff conducts regular checks on resident, and replacing the alarms and ensuring alarms are on at all times. Per discussion, S3 agreed to submit a written plan that they put in place after the incident and submit plan to the Department by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Sep 10, 2025

Basic services shall at a minimum include: 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 interviews and record reviews, R1 left the facility unsupervised in the morning of 4/30/25 at around 3am. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: Per discussion, S3 stated facility made multiple changes including installing camera at the front door, night staff conducts regular checks on resident, and replacing the alarms and ensuring alarms are on at all times. Per discussion, S3 agreed to submit a written plan that they put in place after the incident and submit plan to the Department by POC due date.

Type of visit: Required - 1 Year

On 6/24/2025, at 9:20am Regional Manager Stephenie Doub (RM) and Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their required annual inspection visit. RM and LPA initially met with the staff on duty Licreisha Wilson (S1) and stated the purpose of this visit. The facility supervisor Renae Earl (S2) was notified and arrived shortly after. The Licensee Chukwudi (Patrick) Ikiseh was notified of the visit. Present during this visit were 4 residents in care with one staff on duty. Upon arrival, LPA observed 1 resident in the living room sitting on the sofa watching TV. One resident was at the dining table finishing their meal. Two other residents were in their bedrooms. RM and LPA evaluated the physical plant with S2 to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Areas inspected including but not limited to the kitchen, 5 resident bedrooms, 2 resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clear of obstructions at this time. LPA inspected 5 of 5 resident bedrooms. Bedroom #4 in the facility sketch was observed to be unoccupied and per interview with S2, staff utilize this during the night. In bedroom #1, located by the kitchen area, RM and LPA observed a resident dresser and commode blocking the exit door to the outside. LPA measured the hot water temperature in 1 resident bathroom located in the hallway and was at 104 degrees Fahrenheit. Room temperature was observed at 77 degrees Fahrenheit. LPA observed sufficient seven day non-perishable and two day perishable food supplies. The fire door leading to the hallway where the resident bedrooms are located was observed to be propped open with a door stopper and it was observed to be in disrepair as evidenced by the door closer detached from the wall (photo was taken). {1 of 2} Fire extinguisher located in the kitchen was observed and were last inspected on 6/13/2025. Smoke and carbon monoxide detectors were observed and found to be working during this visit. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care, except for the anti-diarrhea medication that was found in a kitchen drawer. S2 immediately took away the medication upon observation. Facility does not have a fireplace. During an inspection of the garage with S2, LPA observed futon beds to be propped up. Per interview with S2, staff no longer use this garage. Outdoor area was inspected. Facility has one exit gate. Pool was observed to be covered with deck flooring and was observed to be locked and not accessible at this time. There is a covered patio equipped with outdoor furniture. Facility is equipped with solar powered generator. Review of 4 resident files (R1, R2, R3 R4) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Advisory was provided to ensure each resident have PRN authorization letter signed by their physician on file. Medication review was conducted for 2 of the residents (R3 and R4). No issues were noted at this time. Review of 3 staff files (S1, S2, and S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. S1 did not have current First Aid certificate. Per interview with S2 confirms S1 did not complete their First Aid and S1 was observed to be working alone upon arrival. Facility conducts quarterly disaster drill. Facility has a dementia and infection control plan. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during today's visit. Exit interview was conducted and a copy of the report and appeal rights were provided upon exit. {2 of 2}the state’s words, verbatim · CDSS document, Jun 24, 2025

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

On 5/15/2025, at 10:00am, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced to conduct a case management visit. LPA met with Licreisha Wilson, staff on duty (S1), and stated the purpose of this visit. S1 notified the facility supervisor Renae Earl of this visit byut did not answer. LPA also contacted Renae via phone but did not answer; LPA left a message. Chukwudi (Patrick) Ikiseh arrived shortly after during the visit. Renae Earl also arrived later during the visit. Present during today’s visit were 4 residents in care with 1 staff on duty (S1). A brief interview with S1 was conducted. The purpose of this visit is to follow up on the death of Resident_1(R1) occurred on 6/8/2024. The Department was made aware of R1's death during an annual visit on 6/12/2024. The investigation into R1’s death consisted of interviews and record reviews. Per record review of the R1's death certificate, R1's immediate cause of death was cardiopulmonary arrest (onset minutes) and Parkinson's disease (onset years). A review of the Sheriff's Department/Coroner's report concluded that there were no questionable circumstances surrounding R1's death. Based on this case management visit, no deficiencies are being cited. Exit interview was conducted with Renae and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 15, 2025

Type of visit: Case Management - Other

On 5/2/2025 at 2:41pm, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced case management visit to return files to the facility that were removed on 5/1/2025 to be copied at the Regional Office. LPA was met by staff on duty Millicent Brown and stated the purpose of this visit. The facility supervisor, Renae Earl was notified and stated she is unable to be at the facility at this time. Renae gave Millicent permission to sign this report. Present during today's visit were 4 residents in care with 1 staff on duty. LPA Villanueva returned the following files to staff on duty: 5 resident binders (R1 - R5); and 3 staff binders (S1 - S3) Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 2, 2025

Allegation investigated: Staff administered unauthorized medication to resident while in care Staff are not following a resident's licensed physician's orders Staff are mishandling the residents medications Staff do not have adequate food service for the residents

On 09/05/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to deliver complaint findings for the allegations above. LPA was greeted by Staff Member (SM) Winnifred Delpratt and explained the purpose of the visit. LPA asked that SM Delpratt call the Facility Designated Representative (FDR) to inform them that CCL was present. It was learned that FDR Patrick was out of town and was unable to come to the facility at this time. There was one other staff member present, Opal Hall-Hutchins. Current census was 5. A brief interview with FDA was conducted. Allegation: Staff administered unauthorized medication to resident while in care It was alleged that staff administered unauthorized medication to resident while in care. During the course of this investigation, this LPA reviewed facility documentation and conducted interviews. Based on interviews conducted it was learned that facility staff spoke with R1’s responsible party regarding the residents aggressive behavior. It was learned that staff and R1’s responsible party agreed to obtain additional medication from an outside source. However, once the facility obtained the medication it was relied by R1’s responsible party that they no longer wanted to give this medication to the resident. Facility documentation shows that this medication was not prescribed nor was on medication administration record. Based on the information gathered, it is unclear that staff administered unauthorized medication to resident while in care. Unsubstantiated However, once the facility obtained the medication it was relied by R1’s responsible party that they no longer wanted to give this medication to the resident. Facility documentation shows that this medication was not prescribed nor was on medication administration record. Based on the information gathered, it is unclear that staff administered unauthorized medication to resident while in care. Allegation: Staff are not following a resident’s licensed physician’s orders It was alleged that staff are not following a resident’s licensed physicians orders. During the course of this investigation, this LPA reviewed facility documentation and conducted interviews. This LPA conducted 3 staff interviews. 3 out 3 staff members deny that they do not follow the resident’s licensed physician’s orders. It was learned during interviews that the facility administrator consistency informs staff providing information of any changes in medication and ensure that staff understand that new orders. A review of the Medication Administration Record and resident Physician’s orders were conducted where there were no indications to show that the facility did not follow the resident’s licensed physician’s orders. Based on the information gathered, it is unclear if the staff are not following a resident’s licensed physicians orders. Allegation: Staff are mishandling the residents medications It was alleged that staff are mishandling the residents medications. During the course of this investigation, this LPA reviewed facility documentation and conducted interviews. This LPA conducted 3 staff interviews. 3 out 3 staff members deny that they mishandle medication. It was learned during interviews that the facility administrator consistency informs staff providing information of any changes in medication and ensure that staff understand that new orders. A review of the Medication Administration Record and resident Physician’s orders were conducted where there were no indications to show that the facility did not follow the resident’s licensed physician’s orders. Based on the information gathered, it is unclear if the staff are not following a resident’s licensed physicians orders Allegation: Staff do not have adequate food service for the residents It was alleged that staff do not have adequate food service for the residents. During the course of this investigation, this LPA reviewed facility documentation, conducted interviews and reviewed facility records. Based on interviews conducted 3 out 3 staff members deny that they do not have adequate food service for the residents. Staff report that they go grocery shopping once a week for produce and once a month for bigger items or pantry shopping. It was observed during the LPAs visit that the residents enjoyed the food that they were provided for breakfast and lunch and 3 out 3 residents reported no issues at this time. During these visits, this LPA reviewed the facility food to ensure there was an adequate amount of food supply. This LPA observed a sufficient amount of food supply and snacks during the facility visit. In addition, LPA reviewed facility records which show that the facility is conducting grocery shopping for this facility on a weekly basis. Based on the information gathered it was unclear if the facility did not have an adequate food service for the residents. Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported. There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.the state’s words, verbatim · CDSS document, Sep 6, 2024 · control 27-AS-20240604140913

Type of visit: Required - 1 Year

On 06/12/24, 10am, Licensing Program Analysts (LPAs) Ariel Pascua and Arvin Villanueva arrived unannounced at this facility to conduct the required annual inspection. LPAs met with staff on duty (S1), and explained the purpose of the visit. S1 informed Chukwudi (Patrick) Ikiseh via telephone. Patrick arrived at 2pm. During this visit, one staff was on duty with 3 residents in care. At 10:30am LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, other common areas, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a single-story home with a fire clearance to serve 6 non-ambulatory elderly residents and hospice approved for two (2). Facility has 4 resident bedrooms, and 2 bathrooms for resident use. Each resident have their own bedroom. LPAs observed one bathroom and contain grab bars, non-skid flooring, shower chairs, close lid trash containers and hygiene supplies. During an inspection of one of the bathrooms, LPAs found a drain cleaner under the sink and was observed to be accessible to residents in care. Resident bedrooms were observed to be furnished, well-lit and had adequate storage for resident’s belongings. Facility has a dining area off the kitchen and a formal living room. During an inspection of the kitchen area, LPAs observed the knife/sharp drawer was unlocked and accessible to residents in care. In the kitchen refrigerator, LPAs observed a two containers of Lozenges. Per interview with S1, no one is using these Lozenges and S1 threw them in the garbage. LPAs observed the facility to have adequate food supply with at least 2 days’ worth of perishables and 7 days’ worth of non-perishables. LPAs observed the garage to be contain additional food supplies. Also in the garage LPAs observed resident medications inside a small refrigerator. The small refrigerator was observed to be unlocked. Also the door to the garage was unlocked during this visit which makes it accessible to residents in care. Additionally, the garage was observed to have 2 futons, a cabinet, a drawer, a desk and chairs. {Con't to 809-C...} The front yard and the backyard were inspected. Facility has a covered pool but does not contain water. The gate to the pool was observed to be locked and not accessible to residents in care. The backyard is furnished with outdoor furniture for outdoor activities. The deck floor was observed to be in disrepair. The rail for the deck was observed to be slightly bent and loose. Water temperature read 110 degrees F in one of the bathrooms and room temperature reads 76 degrees F. Smoke and carbon detectors were in tested and operational. Fire extinguisher was last serviced on 5/19/23. Medication storage area was observed to be locked and inaccessible to residents in care (except for the medications found in the garage). First aid kit was observed to have adequate supplies and accessible to staff. During staff record review, 3 of 5 staff did not have file available for review. The facility administrator, Mama Ngaima does have a current administrator certificate during this visit. Administrator's training requirements were not available for review at this time. During resident record review, 1 of 4 residents does not have an updated Physicians Report. Last Physician Report was last done on 4/22/2019. 2 of 4 residents in care does not have updated Needs and Services Plan. 1 out of 4 residents were diagnosed as bedridden observed on their 602 however was placed in a non-ambulatory room. 4 of 4 residents do not have PRN Authorization letter. Facility has appropriate internet access available for resident use. During this visit, LPAs did not observe recreational activities being provided to resident. During record reviews, evidence of quarterly fire drills were observed. LPAs also conducted the inspection using the CARE tool. The facility has an approved infection control plan in place. LPAs requested an updated copy of Liability Insurance, LIC 308 and LIC 500 to be email to LPA Villanueva. Per California Code of Regulations, Title 22 and Health and Safety Codes, deficiencies were observed during this visit. Licensee was made aware that an immediate civil penalty of $500 will be assessed during today's visit. Interview was held with Patrick Ikiseh and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 12, 2024

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: POC

On 3/7/24 at 10:30am, Licensing Program Analysts (LPA) Arvin Villanueva arrived at this facility to conduct an unannounced Plan of Correction (POC) visit. LPA initially met with the staff on duty and explained the purpose of the visit. Chukwudi Isikeh, administrator, was notified of the visit by the staff. Staff on duty was given permission to sign this report. The purpose of this visit was to verify the plan of correction that was required to be completed on ____ for deficiencies that were previously cited on a prior visit conducted on 11/27/2023. Present during this visit are 3 residents in care with 1 staff on duty. During this visit, LPA attempted to conduct file reviews of the 4 staff noted on the LIC 500 dated 11/25/23. Staff on duty was only able to retrieve 2 staff files for review at this time. Per staff on duty, the files for the administrators are not present at this facility. Additionally, per interview of staff on duty, staff_1 (S1)noted on the LIC 500 dated 11/25/23 is no longer employed at this facility. LPA also requested S1's files for review but staff on duty is unable to retrieve and stated it is not at this facility at this time. LPA also reviewed resident files and found that resident_1(R1) is using a catheter. Per interview with R1 and staff on duty, it was revealed that R1 is unable to care for their catheter and requires staff assistance at this time. Per interview with Chukwudi Isikeh, a request for an exception for R1's catheter has not been submitted to the Department for approval. Further resident file review revealed that R1 does not have Needs and Services Plan (LIC 625) in their file. LPA requested from the facility to submit an updated LIC 500 to the Department. Con't to LIC 809-C... ...Con't from LIC 809 Based upon this inspection, LPA Villanueva observed the following: The deficiency cited under Health and Safety Code 1569.618(c)(3) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87411(c)(1) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Health and Safety Code 1569.695(c) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87606(c) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Health and Safety Code 1569.618(b)(3) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87412(g) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87412(a)(6)(A) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Title 22 Regulation 87412(a)(12) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Health and Safety Code 1569.625(b)(2) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. The deficiency cited under Health and Safety Code 87219(a)(1) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. Immediate civil penalties are being assessed due to repeat violations. The facility was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected. As a result of this case management, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted with Shyniel Brown, staff on duty, and a copy of the LIC 809 reports, LIC 809-D pages, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Mar 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87616(a) · Plan of correction due date: Mar 8, 2024

87616 Exceptions for Health Conditions: (a) ... the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This is not met as evidenced by: Based on interviews and record review the Licensee did not ensure that a written request for an exception was sent to the Department for approval as soon as R1 started using a catheter. This poses an immediate, health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee to submit a statement of understanding of the regulation related to restricted/prohibited health conditions to the Department by the POC due date. Licensee to submit an exception request, including necessary documents, to the Department for approval. LPA will email licensee what documents are needed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(d)(2) · Plan of correction due date: Mar 13, 2024

(d) The administrator shall have... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This is not met as evidenced by: Based on interviews and record review, the licensee did not ensure that the facility obtained an exception request for R1's indwelling catheter as soon as R1 started using catheter. This poses a potential, health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: The licensee shall provide a statement of understanding regarding the following regulation 87405(d)(2) to the Department by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(g) · Plan of correction due date: Mar 14, 2024

(g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met as evidenced by: Based on interview and record review, licensee did not comply with the section cited above as the files for the administrators were not available for review during this visit.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee to ensure personnel records, including administrators files, are available for review at any time. Licensee to ensure personnel records, including administrators files, are complete as per regulation. Licensee also agrees to read and write a statement of acknowledgment that licensee have read the regulations being cited and have understood the regulation. The written statement is to be submitted to the Department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(h) · Plan of correction due date: Mar 14, 2024

(h) All personnel records shall be retained for at least three (3) years following termination of employment. This requirement is not met as evidenced by: Based on interview, licensee did not comply with the section cited above as the file for S1 who is no longer employed at this facility is present at this facility and not available for review during this visit. This poses a potential, health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee to read and write a statement of acknowledgment that licensee have read the regulations being cited and have understood the regulation. The written statement is to be submitted to the Department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 14, 2024

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Base on record review, the licensee did not comply with the section cited above during resident record review, R1 did not have their Needs and Services Plan (LIC625) on file available for review. This poses a potential, health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee to complete R1's Needs and Services Plan and submit the completed form to the Department by the POC due date.

Type of visit: Post Licensing

On 11/15/23, 10am, Licensing Program Analysts (LPAs) Christina Valero and Arvin Villanueva arrived at this facility to conduct a post-licensing inspection. LPAs met with staff on duty (S1), Shyniel Brown and explained the purpose of the visit. S1 then informed Chukwudi Ikiseh via telephone. Chukwudi is unable to come to the facility during the visit and gave S1 permission to sign this report. During this visit, one staff was on duty with four residents in care. At 10:30am LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, other common areas, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a single-story home with a fire clearance to serve 6 non-ambulatory elderly residents and hospice approved for two (2). Facility has 4 resident bedrooms, and 2 bathrooms for resident use. Each resident have their own bedroom. LPAs observed both bathrooms to contain grab bars, non-skid flooring, shower chairs, close lid trash containers and hygiene supplies. Resident bedrooms were sanitary, furnished, well-lit and had adequate storage for resident’s belongings. The facility common areas are cleaned and furnished. Facility has a dining area off the kitchen and a formal living room. In the kitchen area, LPAs observed the kitchen to be sanitary and free of clutter. Additionally, the kitchen knives and other sharp objects are kept in a locked drawer. Toxins and cleaning supplies are kept locked. LPAs observed the facility to have adequate food supply with at least 2 days’ worth of perishables and 7 days’ worth of non-perishables. LPAs observed the garage to be free of clutter. The garage also houses additional fridge and additional non-perishable food. Additionally, the garage was observed to have couches. {Con't on 809-C} {Con't from 809} The front yard and the backyard are observed to be free of obstruction and well-maintained. Additionally, the backyard has a covered pool but does not contain water. The backyard is furnished with outdoor furniture for outdoor activities. Water temperature reads 105*F to 120*F in one of the bathrooms and room temperature reads 74*F. Smoke and carbon detectors were in good repair. Fire extinguisher was serviced on 5/19/23. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 4 resident files were reviewed for regulatory compliance. Only 1 staffing file were available for review for regulatory compliance during this visit. Evidence of staff training was not available for review during this visit. Additionally, evidence of staff first aid training and certificate was not available for review during this visit. Administrator's files were not available for review to confirm appropriate training were taken. In 2 of the 4 resident files that were reviewed, physician reports needed to be updated. During resident file review, LPAs observed 1 of the 4 residents is bedridden and has a restricted health condition. LPAs completed 2 resident interviews and 1 staff interview. Facility has appropriate internet access available for resident use. During this visit, LPAs did not observe recreational activities being provided to resident. LPAs reviewed facility’s disaster plan to ensure regulatory compliance. During record reviews, evidence of quarterly fire drills were not available for review. LPAs also conducted the inspection using the CARE tool. The facility has an approved infection control plan in place. LPAs requested an updated copy of Liability Insurance, LIC 308 and LIC 500. Per California Code of Regulations, Title 22 and Health and Safety Codes, deficiencies were observed during this visit. Licensee was made aware that an immediate civil penalty of $500 will be assessed during today's visit. Interview was held with the Chukwudi Ikiseh via telephone and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 15, 2023