Caring Heart

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with administrator Kristine Villa and explained the purpose of the visit. LPA Moleski reviewed three resident files (R1-R3) and three staff files (S1-S3). LPA Moleski toured the facility with Villa and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 70 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 115 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 working carbon monoxide/smoke detectors. LPA Moleski observed a minimum two-day supply of perishable food and a minimum seven-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed a locked closet for the storage of cleaning solutions. LPA Moleski observed a locked drawer for the storage of knives. LPA Moleski interviewed two staff members (S1-S2) and two residents (R2, R4). No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Villa.the state’s words, verbatim · CDSS document, Jul 17, 2023

Allegation investigated: Staff touched resident in an inappropriate manor

Licensing Program Analysts (LPAs) Vincent Moleski and Jason Lund arrived unannounced to deliver findings on this complaint investigation. LPAs Moleski and Lund met with care staff Serafin Barut, who called administrator Kristine Villa. LPAs Moleski and Lund spoke with Villa over the phone and explained the purpose of the visit. Villa gave permission to have Barut sign this report. This investigation consisted of facility file review, review of personnel and resident records, review of a police report, and an interview with one resident (R1). During an interview, R1 said he was not touched in an inappropriate manner by staff and he did not believe anything of that nature had occurred. The department has determined the following as it relates to the allegation that staff touched a resident in an inappropriate manner: Unfounded Based on the interview with R1, staff did not touch the resident inappropriately. Therefore, the above allegation is UNFOUNDED. A finding that the complaint allegation is unfounded means the allegation is false, could not have happened and/or is without a reasonable basis No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Barut.the state’s words, verbatim · CDSS document, Apr 13, 2023 · control 27-AS-20230310114156

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jamie Ivey Canady arrived unannounced to conduct a Required - Annual visit on 08/30/2022 at 9:00 AM. Administrator Certificate for George E Aducayen expires 7/11/2023. LPA met with Rodrigo Colegado regarding the purpose of todays visit. Rodrigo contacted the Administrator Kristine Aducayen whom arrived 20 minutes later. The facility is licensed for a capacity of 6 Non-ambulatory of which 1 may be bedridden. Facility has a Hospice Waiver for 6. At this time there are 2 residents receiving hospice services. One hospice resident is currently in the hospital. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed and interviewed residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 106.5*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Liability Insurance Personnel Report (LIC500) Administrator Certificate Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 30, 2022

Type of visit: Office

An Office Meeting was held today in the Sacramento South Adult and Senior Care Regional Office via Microsoft Teams. This meeting was held due to the passing of the Co-Licensee. Those present in the meeting are Regional Manager Krystall Moore, Licensing Program Manager Stephen Richardson, Licensing Program Manager Czarrina Camilon-Lee, Licensing Program Analyst(s) Victoria Brown, and Tung Truong, Co-Licensee Frances Kang, along with facility representatives Maria Kang, and Christine Aducayen-Kang. Currently, Frances Kang is the sole member of the LLC and continues to have Control of Property and of the business. Frances Kang stated there are no changes to the operations of the facility or the finances. To remain in substantial compliance Frances Kang agreed to submit the following: -Updated Secretary of State documents, the intent of Frances Kang is to change the entity (LLC) members. -Change of Ownership Application Part A & B-to be submitted by 11/30/21 *The LIC281 can be downloaded from on-line for application instructions -A copy of the death certificate as soon as it is obtained -A letter to each resident and/or responsible party regarding the intent Frances was advised that should anything discussed to change CCL will be contacted immediately to ensure the health and safety of the residents continue. Frances was advised that health and safety visits will be conducted until the CHOW application is submitted. Also, if there are any concerns or questions to contact LPA(s) Victoria Brown and/or Tung Troung. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted with Frances Kang via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.the state’s words, verbatim · CDSS document, Oct 22, 2021

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - Annual visit on 9/9/21 at 1:45PM. Administrator Certificate expires 7/8/22. LPA met with Christine Aducayen regarding the purpose of todays visit. The facility is licensed for a capacity of 6 Non-ambulatory of which 1 may be bedridden. Facility has a Hospice Waiver for 6. At this time there are 1 residents receiving hospice services. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed and interviewed residents during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 74*F which is within the required range of 68-85*F. The hot water temperature was measured at 108.7*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Liability Insurance Personnel Report (LIC500) Administrator Certificate-Updated Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 9, 2021