Happy Nest IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. LPA met with Claire Camua, Administrator, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and six (6) residents present. Facility Overview: The facility is a one-story home with three (3) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 107°F. Fire extinguisher located at kitchen has current inspection tag. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintainbleed the required two-day supply of perishable foods and a seven-day supply of non-perisha foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Six (6) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 03-08-2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Hilda Ramos, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and four (4) residents present. Facility Overview: The facility is a one-story home with three (3) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment in locked laundry room was in good working condition. Detergents were stored in the laundry room inaccessible to the residents. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 111°F. Fire extinguisher located at kitchen has current inspection tag. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four (4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in a cabinet in living room area. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 3-10-2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jun 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to conduct the required annual inspection. LPA was granted entry and met with Administrator Claire Camua who stated the facility does not have residents at the home. The facility has not had any residents since June 13 2024. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Facility contains an updated Infection Control Plan and Emergency and Disaster plan. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Laundry room contained locked cabinets to store cleaning supplies, soap, and detergents. Centrally stored medication will be locked in a cabinet located in the living room. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items. observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. LPA reviewed two (2) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid. No deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where a copy of this report was provided to Administrator Camua.the state’s words, verbatim · CDSS document, Jun 27, 2024

Type of visit: Case Management - Deficiencies

On 3/13/24 Licensing Program Analyst (LPA) Javina George made an unannounced case management deficiencies visit. LPA met with Claire Itchon, Licensee/Administrator. LPA was at the facility conducting a health and safety check and made the following observations: The facility was observed to have operable utilities (gas, electric, both hot and cold water). Emergency/disaster: LPA observed for the smoke detectors to not be illuminating any light. The Administrator George removed the detectors and the detectors were observed to not connected properly with the wires, as the connector was separated from the device. Once connected properly the detectors were observed to be operable. The facility was noted to have one (1) operable carbon monoxide detector. Food supply: the facility was observed to have a two day supply of perishable and 7 day supply of non perishable food items. LPA observed expired food for there to be three (3) bottles of salad dressing, six (6) bags of expired cereal, a box of mash potato flakes and package of expired cookies. The expired items were discarded at the time of LPAs visit , there will not a be deficiency cited. Medication: the facility has the proper sharps box, a full sharps box that hand needles sticking out was observed to stored outside on the top of the refrigerator, inside the locked garage. Per Administrator George the sharps are discarded when agency staff comes to the facility. Per George agency staff come weekly. LPA observed for the facility to not have a separate refrigerator for medications that require refrigeration. The facility is storing resident medications in the main refrigerator in an unlocked drawer with the vegetables (covered up with the cabbage and lettuce). LPA observed for there a minimum of eight (8) medications such as suppositories, and liquid medications belonging to both current and former resident. A deficiency is being cited in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted as well as copy of this report, appeal rights and LIC9098 Proof of Corrections form was provided to Claire Itchon, Licensee/Administrator.the state’s words, verbatim · CDSS document, Mar 13, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(1)(A) · Plan of correction due date: Mar 27, 2024

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (A) The preservation of medicines requires refrigeration, if the resident has no private refrigerator. This requirement is not met as evidenced by: The licensee did not properly store medications that require refrigeration. Instead the meds were mixed with the fresh vegetables. This posed a potential health safety, and personal rights to persons in care.the state’s words, verbatim · CDSS document, Mar 13, 2024

Plan of correction: The licensee agrees to obtain a separate refrigerator so that the for the medications that require refrigeration can be stored separately from the food. Proof of POC is to be submitted to the department by 5pm on the due date indicated.