Coastal Haven Living

Type of visit: Case Management - Deficiencies

On 04/08/2026, Licensing Program Analyst (LPA) Janette Romero conducted a case management visit to address deficiencies observed while in the facility initiating an investigation into a complaint. During the visit, LPA observed five (5) residents and two (2) staff present. Administrator Jonah Su was informed of the purpose of LPA's visit and arrived to the facility to meet with LPA. During the facility tour, LPA observed Staff 1 (S1) present in the kitchen. Administrator Su described S1 as the facility cook that periodically resides in the facility. S1 was interviewed and reported they volunteer as a facility cook and have resided in the facility on average 3-4 days per week since before the summer of 2025. LPA conducted a record review which revealed S1 does not have a criminal record clearance or approved exemption to work, volunteer, or reside in the facility. During the visit, Staff 2 (S2) was the caregiver present providing care and supervision to the residents. S2 was interviewed and reported working in the facility for the approximately the past three (3) weeks. Administrator Su reported S2 has been working in the facility for approximately one (1) week. LPA conducted a record review which revealed S2 is not associated with the facility. Administrator Su reported on 03/31/2026, Resident 1 eloped from the facility and was hospitalized. However, the facility did not verbally report the incident to Community Care Licensing or submit a written report. Based on the aforementioned, the facility will be cited and civil penalties will be assessed. No additional health or safety concerns were observed during today's visit. An exit interview was conducted and a copy of this report, Confidential Names list (LIC 811), LIC 809-D, LIC 412BG, and Appeal Rights were reviewed and provided to Administrator Su.the state’s words, verbatim · CDSS document, Apr 8, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Apr 8, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or.. This requirement was not met as evidenced by: During the tour, LPA observed Staff 1 (S1) present in the facility. S1 was reported to reside in the facility. LPA conducted a record review which revealed S1 does not have a criminal record clearance or approved exemption to work, volunteer, or reside in the facility. This poses an immediate health/safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Administrator Su escorted S1 out of the facility and reported S1 will not be allowed to return to the premises, indefinitely. POC met.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(3) · Plan of correction due date: Apr 15, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or.. This requirement was not met as evidenced by: During the vist, Staff 2 (S2) was the caregiver present providing care and supervision to the residents. However, a record review revealed S2 is not associated with the facility. This poses a potential health or safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Administrator reported they will contact the Department's Guardian Background Check System and request access to be able to associate staff with the facility. Administrator reported they will email LPA a Criminal Background Clearance Transfer Request (LIC 9182) form for S2 by close of business on 04/15/2026 if they are unable to gain access to Guardian and associate S2 through Guardian. POC to be emailed to LPA by close of business on 04/15/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 30, 2026

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: Administrator Su reported the facility did not verbally report or submit a written incident report to Community Care Licensing to report R1's elopement and hospitalization on 03/31/2026. This poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Administrator Su agreed to contact an outside vendor to receive training for himself and all staff regarding the Department's reporting requirements pursuant to CCR 87211. Proof of training to be submitted to LPA by close of business on 04/30/2026.

Type of visit: Prelicensing

On 2/4/2026, Licensing Program Analyst (LPA) Valerie Flores, Imaculada Vasquez, and Aziz Faizi conducted an announced pre-licensing inspection. LPA's met with Administrator Jonah Su and were granted entry into the facility. LPA's conducted a tour of the interior and exterior areas of the facility and observed the following: The facility is a single-story which consisted of (5) five resident bedroom, (1) one staff bedroom, (4) four bathroom, living room, formal dining room, sun room, kitchen, and sufficient backyard. Resident bedrooms were equipped with the required bedding, furniture, and functional lighting. Bathrooms were observed to have equipped with required grab bars, slip resistant mats, and toiletries. Backyard area was observed to have sufficient shading and was fully furnished. Facility was observed to have (3) three refrigerator and (2) two freezers. LPA's observed a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. LPA's observed emergency food and water located in a pantry. Food prep area was observed to be in sanitary condition. Knives and other sharp items were observed to be stored in a locked cabinet. Laundry service are provided on-site; washer and dryer were observed to be fully operable. Carbon monoxide and smoke detectors were tested and observed to be fully operable. Fire extinguishers were observed to be mounted on the walls throughout the facility. Per Administrator, there are no firearms and/or ammunition on the premises. LPA's observed PUB475, LTCO, Personal Rights, current Administrator Certificate, and emergency disaster plan posted on the wall near the entryway. LPA's observed a locked cabinet which stored centrally stored medication along with staff and resident files. (Continue to LIC809C...) (Continuation from LIC809) LPA's has determined the facility meets the operational requirements for licensure. Final approval of licensure will be determined by the Centralized Application Bureau (CAB). The Pre-licensing inspection is complete and has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted, and a copy of this report was discussed and provided to Administrator.the state’s words, verbatim · CDSS document, Feb 4, 2026

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 3 COMP II Participants: Jonah Su, Applicant/Administrator Interview Method: Virtual interview (Microsoft Teams) On January 16, 2026, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License Type, Client/Resident Populations, and Program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readinessthe state’s words, verbatim · CDSS document, Jan 16, 2026