Rwins Elderly's Haven

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Freida Zapanta, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and three (3) residents present. Alicia Pergantis, Administrator, later joined the inspection at 3:30 PM. Facility Overview: The facility is a one-story home with five (5) 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 105°F. Fire extinguisher located at dining area has new purchase receipt. 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 two (2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) 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 three (3) 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 07-15-2025, 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, Oct 17, 2025

Type of visit: Case Management - Other

This case management inspection is being conducted by Licensing Program Analyst (LPA) Seo Jeon on 08-27-2025 for the purpose of issuing citation for deficiency observed during the investigation into Complaint Control Number 18-AS-20250818141146. LPA met with Alicia Pergantis, Administrator, and explained purpose of the visit. During the visit, LPA reviewed records and observed all three (3) residents' MAR have not been logged or updated with current medication dispenses. Based on observations and records review, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. A copy of this report was provided with LIC809-D and Appeal Rights to the Administrator.the state’s words, verbatim · CDSS document, Aug 27, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(6) · Plan of correction due date: Aug 29, 2025

87465 Incidental Medical and Dental Care (a) (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. Based on records review, Licensee did not maintain residents' medication administation records for all three (3) residents which posed health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 27, 2025

Plan of correction: Licensee agreed to update all medication administration records for all residents and send proof to LPA via email by 08-29-2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection to the facility. The LPA was allowed entrance into the facility and met with Administrator, Alicia Pergantis. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: Physical Plant: The facility consists of four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, storage areas/closets, a kitchen and dinning area, a living room space, a laundry room, a garage, and a patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to Administrator Pergantis, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats or strips present. The carbon monoxide and smoke detector were tested by staff and observed to be in operating condition. Food Service: There is a minimum of 2 days supply of perishable foods and 1 week's supply of non-perishable foods available. A variety of food was available and stored in a safe and healthful manner. Sufficient dinning supplies were available for residents in care. Record Review: There is a disaster and mass casualty plan in place. The facility has a copy of the Plan of Operation available. The Administrator reviewed the facility's profile and reported all information is accurate and up to date. All staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Staff responsible for direct care and supervision have current first aid and CPR training. Dementia care training, postural support training, restricted healthcare training and hospice training was not observed on file for Staff Two (S2) or Three (S3). S2 was interviewed & reported they have had dementia training (3 hours) several months ago. S2 could not recall when other training was completed. S3 was interviewed & could not recall when the training was completed. A citation will issued. The facility was not operating beyond the conditions specified on the license. The facility currently has an approved Hospice Waiver for five (5) residents and there are currently three (3) residents in care receiving hospice services. Six (6) out of six (6) residents did not have a current written record of care on file. A citation will be issued. Medication Review: The LPA inspected medication storage areas. Medications were observed to be inaccessible to unauthorized individuals. Medication Administration Records (MARs) are being maintained by the facility. The Administrator was also issued Technical Advisories and Violations for violations that did not pose an immediate threat to residents in care. An exit interview was conducted with Administrator Pergantis in which this report was reviewed and a copy was provided, along with the LIC 858, LIC 859 and instructions on appeal rights. LPA addressed Administrator questions relating to the report.the state’s words, verbatim · CDSS document, Oct 10, 2024