Home Sweet Home Van Buren

Allegation investigated: Facility is in disrepair Staff do not ensure the residents rooms are clean and sanitary

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to the facility above to issue final findings. Upon arrival, LPA met with an Administrator Michelle Parr and explained the reason for the visit. Facility Manager Karthiga Vijayakumar arrived shortly thereafter. During the initial visit on 08/26/26 LPA Cortez interviewed Manager Karthiga Vijayakumar and conducted interviews with two (2) guests and conducted a physical plant tour. During the investigation LPA interviewed a facility visitor and reviewed and discussed notes with LPA Cortez. During today's visit LPA toured the facility and interviewed staff. Continue on 9099-C page 2 Substantiated Allegation: Facility is in disrepair It was alleged the television has been broken for over a month with no sound. On 8/26/26, LPA Cortez interviewed staff who acknowledged that the television sound was not working, stated that it had been repaired, and reported that it had recently malfunctioned again. Interviews conducted prior to arrival with witnesses confirmed that the television sound had not been functioning during multiple visits. During today’s visit, staff informed LPA Rankin that the television sound had previously not worked but had since started working; staff were unsure whether the television had been replaced or the sound issue repaired. LPA confirmed that as of today’s visit, the television sound was functioning. LPA also observed that the flooring throughout the facility is beginning to split apart, resulting in small cracks and areas of peeling. This was noted in the living room, dining room, kitchen, laundry room, main hallway, and in two resident bedrooms. At this time, the concern is the flooring condition will soon pose a potential trip hazard for mobile residents, visitors, and staff. The situation, at this time, did not pose an immediate health and safety risk to residents in care, this is considered a technical violation, and no citations are being issued at this time. A Technical Violation is issued related to this allegation, for section 87307 (d)(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. Allegation: Staff do not ensure the residents’ rooms are clean and sanitary It was alleged that residents’ rooms are filthy, with cobwebs and dirty floors. On 9/10/26, LPA Rankin conducted a tour of the facility. LPA observed minimal debris on the bedroom floors and did not observe any cobwebs in residents’ rooms at the time of the visit. However, LPA noted that resident bathrooms had multiple areas of concern. Continue on 9099-C page 3 LPA observed cobwebs in the corner of the window above the stove. Several kitchen cabinet doors appeared soiled, with visible brown spotting and residue. The wall and floor near the refrigerator contained dirt and spill marks. Baseboards throughout the facility had a noticeable layer of thick dust and dirt. The resident bathrooms also showed significant concerns: the tile grout around both showers/tubs was dark brown to black in color, with visible grime along the ledges. The bases of the toilets and the surrounding floor areas had urine residue and additional dirt and grime buildup. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Based on observation and interview, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. Copy of report and appeal rights printed and provided to facility.the state’s words, verbatim · CDSS document, Sep 10, 2026 · control 29-AS-20260825152629

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2)(A)(B) · Plan of correction due date: Sep 25, 2026

87470 Infection Control Requirements(a)A licensee shall ensure that infection control practices are maintained as follows:(2) Environmental cleaning and disinfection activities shall be performed…These activities shall be completed, at a minimum...:(A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated and visibly soiled with…body fluids or other potentially infectious material. (B) Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary and when they are visibly contaminated or soiled.the state’s words, verbatim · CDSS document, Sep 10, 2026

Plan of correction: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above when they failed to conduct routine infection control maintenance and cleaning in the bathroom, kitchen, and along the baseboards and flooring throughout the facility which poses a potential health and safety risk violation to residents in care. POC: Facility will have an initial deep cleaning done by a professional, images of bathroom showers and kitchen area will be sent to LPA. A routine schedule will be created and emailed to LPA.

Type of visit: POC

Licensing Program Analyst (LPA) Rankin conducted a Plan of Correction (POC) Visit to the facility above to verify that a correction had been addressed for complaint 29-AS-20260825152629. Upon arrival, LPA met with an Administrator Michelle Parr and explained the reason for the visit. Facility Manager Karthiga Vijayakumar arrived shortly thereafter. During today's visit LPA toured facility, reviewed temperatures throughout the facility, discussed what had been done to address the concerns of the temperature reaching above the allowed regulation of 85 degrees. Upon entering the facility, in the common area, LPA noted two portable air conditioning units, one, that was in use, and one not set-up for use. LPA also noted one fan in the common area. During tour, LPA noted 2 additional fans in the living room area, 2 fans in two resident rooms and at least 1 fan in the rest of the residents room. The temperature in resident 1 (R1) room was 83 at approximately 10:15 am and was at 85 degrees at approximately 11:30 am. LPA tested the temperature in Resident 2 (R2) room, it was reading at 82 degrees at approximately 11:25 am. LPA Cortez cited the facility on 8/26/26 for the temperature reaching 90 degrees during the initial visit. The administrator agreed on 8/26/26 to install additional AC units, plural, by 8/27/26. As of today's visit, the initial AC unit was the only unit turned on. Continue 809-C LPA explained to the administrator that additional civil penalties of $100 per day will be assessed if LPA returns and temperature is not being maintained within regulations. LPA explained that it is understood there is a heat advisory throughout the area, but that the facility has had since 8/27/26 to show effort and/or request an extension on the Plan of Correction date. As of the time of this report, LPA recorded the temperature at 87 in the common room and 87 in Resident 2 room and 89 degrees per clock in R1 room and 85.6 in various parts of the rest of the facility. A copy of this report and Failure to Correct Civil Penalty Assessment has been printed and provided to the facility.the state’s words, verbatim · CDSS document, Sep 10, 2026

Allegation investigated: Staff do not provide comfortable temperature to residents

Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegations. Upon arrival, LPA met with staff and explained the reason for the visit. Facility Manager Karthiga Vijayakumar arrived shortly thereafter and was explained the reason for the visit. Entrance interview conducted. During today's inspection, between 04:00 p.m. and 6:00 p.m., the LPA interviewed the Facility Manager, two guest, conducted a tour of the facility and checked the temperature in all of the resident bedrooms. Report will continue on LIC9099-C,2nd page. Substantiated On the allegation “Staff do not provide comfortable temperature to residents,” it is the concern of the Reporting Party (RP) that the facility is excessively hot, noting the indoor temperature reached 88 degrees Fahrenheit. At 4:08 p.m., the Licensing Program Analyst (LPA) conducted a comprehensive tour of the home and observed the living room temperature to be 88 degrees Fahrenheit, as displayed on a digital clock equipped with a temperature reading. The LPA observed three portable fans and one window air conditioning (AC) unit operating in the living room. Staff disclosed that the window AC unit and one of the portable fans in the living room were provided by resident’s family. At 4:08 p.m., the LPA inspected room number one and observed a small portable fan, which staff confirmed was also provided by the resident’s family. A small digital clock inside room number one indicated a temperature reading of 86 degrees Fahrenheit. The LPA observed that room number two lacked any cooling devices and felt noticeably warm. Upon this observation, staff immediately placed a portable fan into room number two. The LPA verified that the remaining resident bedrooms each contained one portable fan. From 5:13 p.m. to 5:17 p.m., the LPA measured the temperature of each bedroom using a facility-provided infrared thermometer set to the room temperature reading mode; every resident room registered at 86 degrees Fahrenheit. The facility does not have thermostats installed in the residents’ rooms. The Administrator stated that the home lacks a centralized AC unit and relies entirely on portable fans and the single living room window AC unit to cool the premises. Two visitors interviewed during the inspection stated that the home felt clammy and hot. The LPA also experienced the indoor environment to be uncomfortable, clammy, and warm throughout the visit. At 5:42 p.m., the digital clock in the living room indicated that the temperature had risen to 90 degrees Fahrenheit. Based on the evidence obtained, specifically the indoor temperatures measuring up to 90 degrees Fahrenheit, which exceeds the regulatory limit mandated by California Code of Regulations Title 22, the Department has determined there is sufficient evidence to support the allegation. Therefore, the allegation is Substantiated at this time. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued. Exit interview conducted. Today's report was reviewed and Provided.the state’s words, verbatim · CDSS document, Aug 26, 2026 · control 29-AS-20260825152629

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(b)(2) · Plan of correction due date: Aug 27, 2026

87303 (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C)...less than the outside temperature. This requirement is not met as evidenced by:Based on observation and interview, the temperatures inside the facility measured between 86 and 90 degrees Fahrenheit inside, which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 26, 2026

Plan of correction: Administrator indicated new air conditioning units will be delivered and installed by 08/27/2026. Administrator will attempt to find out if an AC unit can be purchased and installed today. Proof of new installed AC units will be submitted to LPA by 08/27/26.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek conducted a required annual visit. LPA met with Administrator Karthik "Raj" Kanakaraj and facility Designee Karthiga "Karthi" Vijayakumar and explained the reason for the visit. Beginning at 12:08PM, LPA, along with Administrator and Facility Designee, conducted the physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was observed: The fire extinguishers appeared fully charged and were purchased 02/23/2026. The hardwired smoke detectors and the carbon monoxide detector were tested and functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of non-perishable and perishable food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Knives are stored in a locked drawer. COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. The laundry room door leading to the garage was locked. The garage contains more perishable food, water, PPE, incontinence supplies and cleaning supplies. BEDROOMS: There are eight (8) total bedrooms in the facility; six (6) bedrooms are designated for resident use and two (2) for staff. The staff rooms are kept locked. All resident rooms were observed to be furnished appropriately with clean linens and sufficient lighting. Report Continued on LIC 809-C BATHROOMS: There are two (2) bathrooms for resident use. Bathrooms were observed to be equipped with slip-resistant surfaces and grab bars. The water temperature was measured at 106*F. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Five (5) staff files and six (6) resident files were reviewed and in compliance with regulations. All training were observed to be complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last documented drill on 03/21/2026. MEDICATION REVIEW: Medications for two (2) residents were reviewed. Medications observed were labeled, stored, and properly documented at the time of the visit. Medications appear to be given as prescribed. INTERVIEWS: LPA interviewed two (2) residents, one (1) family member and two (2) staff. No concerns noted. No deficiencies cited. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Apr 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara conducted a required annual visit. LPA met with administrator Karthik "Raj" Kanakaraj and explained the reason for the visit. LPA conducted the physical plant tour to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The fire extinguishers appeared fully charged and were purchased 4/1/2024. The hardwired smoke detectors and the carbon monoxide detector were tested and functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of non-perishable and perishable food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Knives are stored in a locked drawer. Water temperature was 105*F. COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. The laundry room door leading to the garage was locked. The garage contains more perishable food, water, PPE, incontinence supplies and cleaning supplies. BEDROOMS: There are eight (8) total bedrooms in the facility; six (6) bedrooms are designated for resident use and two (2) for staff. The staff rooms are kept locked. All resident rooms were observed to be furnished appropriately with clean linens and sufficient lighting. Report Continued on LIC 809-C Report Continued from LIC 809 BATHROOMS: There are two (2) bathrooms for resident use. Bathrooms were observed to be equipped with nonskid mats and grab bars. The water temperature was measured at 105*F. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Three staff files and five resident files were reviewed and in compliance with regulations. All training were observed to be complete. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are usually conducted quarterly. In 2024 they conducted the drills quarterly. In 2025, there were staff away on vacation so the first drill was postponed to April. The administrator plans to conduct drills in April and June to catch up. The facility's emergency disaster plan was observed to be complete, however it has not been updated with the new administrator's information. MEDICATION REVIEW: Medications for two (2) residents were reviewed. Medications observed were labeled, stored, and properly documented at the time of the visit. Medications appear to be given as prescribed. INTERVIEWS: LPA attempted interviews with two (2) residents. LPA interviewed two (2) staff. No concerns noted. No deficiencies cited. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Apr 3, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kelly Dulek conducted a pre-licensing visit to this property at 09:30AM. LPA met with applicant representative Karthiga Vijayakumar, Karthik Kanakaraj and Administrator Gloria Valencia. This application is for a Change of Ownership Application (CHOW) and the current licensed facility has residents in care. The applicant has obtained fire clearance for 5 (five) non-ambulatory and 1 (one) bedridden with a total capacity of six (6) residents. The applicant representatives indicated the proposed facility has a pending Dementia care plan and a pending hospice care waiver for 5 (five) residents. Applicant completed component II interview on 01/11/2024. During today's visit, all facility representatives completed component III with the LPA. Beginning at 09:38AM, LPA inspected the proposed facility for Fire Safety, Personal Accommodations, and Food Service. All hard-wired combination smoke alarm and carbon monoxide detectors were tested at 12:00PM and function properly at this time. Fire extinguisher was observed to be fully charged and purchased on 04/01/2024. Paint, windows, blinds, and floors are in good repair. There are no firearms on the premises. The common living and dining areas are clean and properly furnished. A working telephone is present. The proposed facility has 8 (eight) bedrooms total, of which 6 (six) are private resident rooms and 2 (two) are designated as staff rooms. All resident bedrooms observed were furnished and contained beds, chairs, bedside tables and lamps. All beds have appropriate linens. There is also an ample supply of linen, towels and paper products. The proposed facility has 3 (three) bathrooms, 2 (two) are for shared resident use and 1 (one) is a staff restroom. LPA observed night-lights were present in the hallways. Hot water was measured in shared resident restroom and measured within the required range. The kitchen contained a sufficient supply of dishes, glasses and utensils. A seven-day supply of Report Continued on LIC 809-C non-perishable food is present, as well as, a seven-day supply of emergency water. Knives were stored in a locked drawer and cleaning supplies are stored in the locked garage. The facility contains a laundry area, containing locked cabinets. A locked medication cabinet was observed, as well as an inaccessible cabinet designated for record storage. First aid kit was observed and was complete. Building and grounds were observed. Patio area contains a shaded seating area for resident use. Outdoor exit gate was observed to be self-closing and self-latching at this time. All passageways were observed to be clear of hazards. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 8, 2024