Mahaloha Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Sashana Barnett, caregiver, and explained purpose of inspection. Administrator, Gerald Rivera, arrived at 10:15 am. LPA observed (1) resident in the common area and (3) residents in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (5). Currently there is (1) resident on hospice. LPA and the caregiver toured the interior/exterior of the facility including common areas, (1) shared resident bedroom, (4) private resident bedrooms, (2) bathrooms, kitchen, staff room, laundry area and outside patio. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, skid-resistant flooring, hygiene supplies, and a trash can with a lid. There is sufficient 2+day perishable food, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen, and medications are secured nearby. The fire extinguisher was last serviced 2/12/26. Disaster drills being conducted. Smoke/monoxide alarms are working. Inside temperature measured 71*F. Hot water temp measured 124*F in a resident bathroom (sign posted). There are sufficient linens/towels/blankets and PPE. Administrator Certificate #7026858740 (exp 12/26/27)- Administrator to post a current copy. The pool is currently filled with dirt and is gated/locked. Patio seating is covered. Required postings are visible in common area, including a facility sketch with utility shut off valve locations. Exit doors have alerts and there are no blockages present. Annual fees are due by 5/1/26. LPA reviewed (2) resident and (2) staff files. Files were organized and contained required documentation. Medications were reviewed for (2) residents- orders matched medications being administered- an updated list will be obtained to reflect discontinued medications. Staff have current First Aid/CPR certifications. Updated copy of LIC308, LIC500 and insurance requested by 3/19/26. There are no deficiencies issued in this report. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Mar 12, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Sashana Barnett, caregiver, and explained purpose of inspection. Administrator, Gerald Rivera, arrived at 12:00 pm. LPA observed (1) resident in the common area and (4) residents in their rooms at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (5). Currently there is (1) resident on hospice. LPA and the caregiver toured the interior/exterior of the facility including common areas, (1) shared resident bedroom, (4) private resident bedrooms, (2) bathrooms, kitchen, staff room, laundry area and outside patio. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring, paper towels, trash can with a lid, and a 20-second hand-washing poster. LPA observed sufficient 2+day perishable food, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen, and medications are secured nearby. The fire extinguisher was last serviced 1/10/25 and facility will be sure to conduct (2) disaster drills each quarter. Smoke/monoxide alarms are working. Inside temperature measured 73*F. Hot water temp measured 126*F in the kitchen and in a resident bathroom. There is a sign posted at the kitchen sink and additional signs will be posted in the bathroom(s). Water temperature was lowered during the inspection but still measured over 120*F. There are sufficient linens/towels/blankets and PPE. Administrator Certificate #6061379740 - exp 12/26/25. The pool is currently filled with dirt and is gated/locked. Patio seating is covered. (3) resident files were reviewed. Files are organized and contain current physician's reports and updated care plans. Medications were reviewed for (1) resident- orders matched meds. All staff is cleared/associated. Staff completed required (20) hours annual training in December 2024. Will complete (6) hours of medication training by 3/20/25. At least (1) staff has current CPR and staff to complete First Aid by 3/13/25. Administrator purchased an updated Dementia care plan during today's inspection. Updated copy of insurance obtained. There are no deficiencies. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Mar 13, 2025

Type of visit: Office

On 2/7/2025, at 2:00 PM, a Non-Compliance Conference meeting was held with Sacramento North Regional Office via Microsoft Teams Meeting. Present in the meeting was Licensee, Gerald Rivera, Regional Manager (RM) Alycia Rayner, Licensing Program Manager (LPM) Maribeth Senty, Licensing Program Manager (LPM) Troy Ordonez, and Licensing Program Analyst (LPA) Sabrina Calzada. Topic discussed during this meeting were: An incident that occurred on 12/31/24, at another facility where the Administrator worked, and how (8) residents were left unattended and unsupervised, for approximately (1.5) hours. The incident was discussed in detail and how it relates to Administrator qualifications, duties and responsibilities. The licensee was in agreement with the drafted non-compliance plan as outlined in LIC 9111. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is also being cited on the 809-D page. An exit interview was conducted and a copy of this report and appeal rights will be provided to the facility via email. A copy will be signed and returned to CCLD.the state’s words, verbatim · CDSS document, Feb 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87408(a)(6) · Plan of correction due date: Feb 17, 2025

87408 Denial or Revocation of a Certificate (a) The Department may deny or revoke any administrator certificate for violation of licensing regulations or on any of the following grounds: (6) The certificate holder engaged in conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that the Administrator did not engage in conduct inimical, on the evening of 12/31/24, at another CDSS licensed care facility, when (8) residents were left unattended for approximately an hour and a half, which posted an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 7, 2025

Plan of correction: The Licensee/Administrator agree to submit all documents, and complete any training or tasks listed on page 3 of the LIC9111, dated 2/7/25, that was discussed during the meeting on 2/7/25. All documents related to the above to be submitted to CDSS by email/fax by 2/17/25.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection. LPA met with Sashana Barnett, caregiver, and explained purpose of inspection. The care staff contacted the Administrator, Gerald Rivera, who arrived at 1:45 pm. LPA and the caregiver conducted a tour of the interior of the facility. LPA observed (4) residents currently resting in either their room or the common area. LPA was advised there is (1) resident who was out of the facility at the start of the inspection. That resident later returned by the end of the inspection. LPA asked the Administrator if he has any related facilities that are licensed with the Department or if he works at any other facilities. The Administrator indicated he does not have any other licensed facilities but works part-time at another licensed care home in the area and provided details to an incident occurring on 12/31/24. There are no deficiencies issued in this report. Exit interview. Copy of report provided to the Administrator.the state’s words, verbatim · CDSS document, Jan 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada and IB Investigator Nathan Gonzalez arrived unannounced to conduct an annual inspection. LPA met with Sashana Barnett, caregiver, and explained purpose of inspection and then with Administrator, Gerald Rivera, who arrived at 10:30 am. LPA observed (4) residents in the common area eating breakfast at the start of the inspection and (1) resident was in his room, The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (5). Currently no residents are on hospice. LPA and the Administrator toured the interior/exterior of the facility including common areas, (1) shared resident bedroom, (4) private resident bedrooms, (2) bathrooms, kitchen, staff room, laundry area and outside patio. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring, paper towels and 20-second hand-washing poster. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen. Medications are secured nearby. Fire extinguisher last serviced 1/8/24 and smoke/monoxide alarms are working. Inside temperature measured 72*F and hot water temp measured 120* F in the kitchen and in a resident bathroom. There are sufficient linens/towels/blankets and PPE/paper products. Administrator Certificate #6061379740 is pending renewal. There is a gated/locked pool in the process of being converted to an extended patio. Patio seating is covered. First aid kit is complete. LPA checked (3) resident files and found them to be organized and contain current documentation. Medications were reviewed for (2) residents and matched orders on file. The facility uses a computerized system for medication management including medication documentation. LPA reviewed (3) current staff files. All staff is cleared/associated and has current First Aid/CPR on file. Staff has completed required annual training. Infection Control Plan was reviewed/approved. Emergency Disaster Plan is complete. Copy of current liability insurance on file. Copy of LIC308 and LIC500 to be provided by 3/22/24. There are no deficiencies issued. There are (2) Technical Advisory Notes issued today. Exit interview. Report provided.the state’s words, verbatim · CDSS document, Mar 15, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection. LPA met with Sashana Barnett, caregiver, and explained purpose of inspection and then with Administrator, Gerald Rivera, who arrived at 12:45 pm. LPA observed (4) residents in the common area at the start of the inspection and the caregiver preparing for lunch to be served. (1) resident was in his room, The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (5). LPA and the Administrator toured the interior/exterior of the facility including common areas, (1) shared resident bedroom, (3) private resident bedrooms, (1) vacant private resident bedroom, (2) bathrooms, kitchen, staff room, laundry area and outside patio. LPA observed the facility to be clean, in good repair and odor-free. Bathrooms have the necessary grab bars, non-skid flooring, paper towels and 20-second hand-washing poster. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps and toxins in the kitchen. Medications are secured nearby. Inside temperature measured 76*F and hot water temp measured 112* F in a resident bathroom. Hot water measured 128* in the kitchen- sign to be posted today- resident do not use this faucet. Fire extinguisher last serviced 1/3/23, and the smoke/monoxide alarms are working. LPA observed required postings- including the Ombudsman, See Something Say Something, LIC610E, facility sketch, Personal Rights, License, and Admin Certificate #6061379740- exp 12/26/23. Administrator will submit documentation for the renewal by 12/26/23. There is a gated/locked pool that is in the process of being filled with dirt to use the area as a patio. LPA checked (3) resident files and found them to be organized and contain current documentation. Facility paperwork matches new facility name. Medications were reviewed for (1) resident and matched orders. The facility uses a computerized system for medication management. LPA reviewed (3) current staff files. All staff have current First Aid/CPR on file. Staff to ensure the required (20) hours of continuing education is completed within each 12-month period. All staff is cleared and associated. Addendum to be added to Admission Agreement to update address for CCLD and add email/website for CCLD and LTCO. Facility to also update copy of personal rights to include most current copy, as posted. Infection Control Plan was complete. Emergency Disaster Plan needs to be finished. Copy of current liability insurance to be provided by 12/29/23. There are no deficiencies issued. Exit interview. Report provided.the state’s words, verbatim · CDSS document, Dec 14, 2023