Kimochi Home

Type of visit: Required - 1 Year

On 5/11/2026, LPA Grace Donato conducted an unannounced annual insprection and met with Director of Residential Services, Linda Ishii and explained the purpose of the visit. The facility currently provides care for 17 residents some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located throughout the facility were found to be charged. Smoke and carbon monoxide detectors were present. Emergency disaster plan is reviewed and completed. Disaster drills are conducted on a quarterly basis and documented. There was a sufficient supply of both perishable and nonperishable foods. There was a supply of hygiene products and paper products available for residents. Resident's bedroom have lighting & appropriate furnishings and bedding items. Restrooms for resident use were equipped with non-slip mats, grab bars and kept in good condition. There is a large outdoor patio equipped with appropriate shading for resident use. Medications are stored in staff office and found to be in a locked metal cabinet. Upon spot review of medications, LPA found that the facility has centrally store medication records updated and in order. LPA conducted a sample file review for residents and found all items to be current. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Required - 1 Year

On 5/30/2025, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Executive Director, Linda Ishii. The facility currently provides care for 14 residents some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located throughout the facility were found to be charged. Smoke and carbon monoxide detectors were present. Emergency disaster plan is reviewed and completed. Disaster drills are conducted on a quarterly basis and documented. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen refrigerator found to have appropriate coverings, enough for residents in care. There was a supply of hygiene products and paper products available for residents. Resident's bedroom have lighting & appropriate furnishings and bedding items. Restrooms for resident use were equipped with non-slip mats, grab bars and kept in good condition. There is a large outdoor patio equipped with appropriate shading for resident use. Medications are stored in staff office and found to be secured. Upon spot review of medications, LPA found that the facility has centrally store medication records updated and in order. LPA conducted a sample file review for residents and found all items to be current. Upon a sample review of staff files LPA found that all caregiver staff have current 1st aid and CPR certification and health screening on file. The facility is also on track for completing staff annual training. LPA requested the following documents be sent to CCL by COB 6/13/2025: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan No deficiencies citedthe state’s words, verbatim · CDSS document, May 30, 2025

Type of visit: Case Management - Incident

On 8/20/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a case management, following up on facility incident report. An incident occurring on 8/17/2024 involving resident (R1) leaving the facility unassisted. LPA toured the facility and interviewed Director of Residential Services, Linda Ishii. Based on interview, R1 had not previously demonstrated this behavior or desire to leave the facility site. The facility contacted appropriate parties including local police department and R1's POA and submitted an incident report to CLLD. R1 had been located at the local medical center in close proximity to the facility. R1 was assessed and found no signs of injury or changes of condition and safely returned. Based upon a review of R1's records, it was found that R1 is cleared by their physician to leave the facility unassisted and does not have a diagnosis of dementia. LPA and Administrator discussed several items following the incident, including supervision and reassessments for R1, in order to prevent further incidents from occurring. Facility to provide LPA with copies of R1's updated records once completed. In addition, LPA and Director of Residential Services discussed request for Fire Clearance Inspection. LPA was provided request documentation. Facility to provide updated facility sketch prior to LPA submitting inspection request to local fire department. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Aug 20, 2024

Type of visit: Required - 1 Year

On July 31, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:40 AM to complete the Annual 1-year required inspection. LPA Calandra was greeted by Sandy Ishii, Adult Day Care Program Coordinator and explained the purpose of the visit. Linda Ishii, Administrator arrived later during the visit. LPA Calandra toured the physical plant. This is a 2-story building with 14 bedrooms, 4 bathrooms, a kitchen, dining room, lounge, garden, foyer, staff offices, and recreation room. All bedrooms had the required furniture and sufficient lighting. The facility's thermostat was set at a comfortable temperature of 72.5 degrees Fahrenheit. Hot water temperature was measured at 114.8 degrees Fahrenheit within the required range. The facility had the required 7 days of non-perishables and 2 days of perishables on hand. No food was expired. The facility's fire extinguishers were last inspected on January 28, 2024 and all were observed to be fully charged. The facility's smoke detectors and carbon monoxide detectors were observed to be in working order. All soaps, detergents, and poisons were observed to be locked and in-accessible to persons in care. Knives, and other sharp objects were accessible to persons in care but locked in the presence of the LPA. This facility does not handle cash resources for clients. LPA Calandra reviewed Centrally Stored Medications Records(CSMR). A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. LPA Calandra reviewed 5 client records and 5 staff records. All client records were observed to be missing the Annual Needs and Services Plan. All staff files were observed to be complete. A Type B violation was provided for not having Annual Needs and Services Plans for R1, R2, R3, R4, and R5. A Technical violation was also provided for not ensuring Appraisals are conducted for Dementia patients on an ongoing basis. LPA Calandra requested the following documents be sent to the Department: -Current Liability Insurance -Transportation Procedures Deficiencies are cited under California Code of Regulations, Title 22, cited on the LIC 809-D. Failure to correct the deficiencies may result in civil penalties. An exit interview was conducted. This report was reviewed with Linda Ishii, Administrator and a copy of the report left at the facility along with Appeal rights.the state’s words, verbatim · CDSS document, Jul 31, 2024