Cyon Samala Family Care Home #2

Type of visit: Required - 1 Year

On September 22, 2026, at 9:00 AM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Administrator 1 (A1) Hiyasmin Samala and explained the purpose of today's visit. The Administrator holds current certificate #7033096735 and expires on May 28, 2027. The facility is licensed for six (6) clients ages 60 and above. There are currently five (5) clients residing at the facility. At 9:20 AM, LPA conducted record reviews of five (5) staff and five (6) client files. The staff files were observed to contain updated training records. Client files contained needs and services plans, health screening reports, and TB test records. At 10:30AM, LPA reviewed two (2) Clients' medication administration records. Medications were stored in a locked cabinet. The facility uses a MAR sheet to record all dispensed medication. The facility conducts monthly fire drills and the most recent one took place on August 2, 2026. At 10:45AM, LPA Lopez toured the physical plant including but not limited to the kitchen, dining room, resident bedrooms, facility bathrooms, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility kitchen was observed to contain at least 7 days worth of non-perishable food supply and at least 2 days of perishable food supply. The facility stores knives in a locked container. Cleaning supplies and toxins were stored in a locked cabinet under the sink. Continued on LIC 809-C. The dining room was clean and free of hazards. There was enough seating available for the current census. LPA observed residents listening to music and coloring in the common areas. LPA observed a public telephone available for resident use in the living room. LPA toured the facility restrooms which were clean and sanitary. The shower contained non-slip mats and grab bars for resident safety. LPA toured 3 out of 3 client bedrooms. The bedrooms contained clean bedding and the furniture was in good repair. The client bedrooms contained smoke detectors and exit doors. LPA observed a resident bed who is no longer at the facility. It was learned that the resident resided at the facility for 1 day and was hospitalized shortly after. LPA reviewed fax records and email records but did observe any incidents reported for the facility. LPA reviewed Reporting Requirements with A1. The facility temperature was 73 degrees. The facility's hot water temperature was 106 degrees. The fire extinguishers were serviced annually on September 14, 2026. The facility courtyards were observed to contain a shaded seating area for resident use. The walkways were clear of obstructions. The LPA observed piles of cardboard which Staff 1 (S1) stated will be picked up by waste management tomorrow. LPA Lopez requested the following documents be sent to the Regional Office within 15 days: LIC 500 Personnel Report, LIC 308 Designation of Facility Representative, LIC 610E Emergency and Disaster Plan, and copy of surety bond. As a result of this annual inspection visit, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 22, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Administrator Hiyasmin Samala, and explained the purpose of the visit. LPA Valerio and Administrator toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed two direct care staff and four residents in the living room. Common areas were observed to be fully furnished, clean, and free from odors. Resident bedrooms were observed to be fully furnished, personalized to each individual, and free from debris. Resident bathrooms were observed to be clean, fully stocked with hygiene supplies, and free from odors. The kitchen and pantry was observed to have an adequate food supply along with an emergency supply. Storage areas were observed to be used for extra miscellaneous items. Medications, sharps, and toxins were observed to be locked and inaccessible to residents in care. Emergency exits were free from obstructions. LPA Valerio observed resident The last fire drill was held on 09/13 and 09/14/2025. The facility had a fire extinguisher with a last annual service check on 08/23/2025. No health or safety concerned observed. LPA Valerio reviewed three (3) staff files and two (2) resident files. Staff files were up to date with annual training. Resident files were complete with required documentation. LPA Valerio requested the following documents be sent to LPA Viarella: LIC 500, LIC 308, LIC 610, and copy of surety bond Per California Code of Regulations - Title 22, no deficiencies were observed today. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 9, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Vincent Moleski and Holly Williams arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Hiyasmin Samala and explained the purpose of the visit. LPA Moleski reviewed five resident files (R1-R5) and three staff files (S1-S3). LPA Moleski toured the facility with Samala and inspected common areas, the kitchen, bedrooms, and bathrooms. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 111 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives. LPAs Moleski and Williams interviewed one staff member (S1) and three residents (R1, R3-R4). No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Samala.the state’s words, verbatim · CDSS document, Sep 19, 2024