A&K Silver Creek Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Gloria Anyiam, Caregiver. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Three (3) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance-1 has no association, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current 09/17/2027. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 111.0 degrees F. (Continued on LIC809, Page 2) (Continued from LIC809, Page 1) Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in an area in the garage; the machines have been relocated from the designated laundry room. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location Food Service- Food supply meets one week supply of nonperishable and 2-day supply of perishables food on hand. Food prep areas are clean and organized. LPA made observations throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure has been changed according to the approved floor plan-the designated laundry room has been converted into a caregiver room, garage was observed setup with mattress, personal furniture and belongings to Administrator. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 05/7/2026. The facility is not conducting emergency disaster drills every quarter, documentation observed for 4/2/2026 and 10/3/2025. Based on the information received during this visit today, there are three (3) deficiencies and Civil Penalties issued for $200 is being cited per Title 22, Division 6 of The California Code of Regulations. This report, 809D, Appeals Rights, LIC421BG and Civil penalties was reviewed with Alan Nakamure and a copy provided at the time of the exit interview.the state’s words, verbatim · CDSS document, May 7, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Seo Jeon conducted an announced visit to conduct a Pre-licensing inspection. LPA met with Alan Nakamura, Administrator, for a Residential Care Facility for the Elderly (RCFE) with a capacity of six (6) residents. The facility is a single story home with five (5) bedrooms, two (2) bathrooms, and an attached garage. There are five (5) resident bedrooms, kitchen/dining area, a living room area, a laundry room, and a backyard. The facility does not have any firearms or ammunition. There is a fenced pond with locked gate in the backyard. LPA toured the interior and exterior areas of the facility. The following were inspected: All bedrooms have the required bedding and furniture, night-stands, dressers, chairs, lighting, and emergency lighting. The bathroom appliances were operating in safe and sanitary condition. The bathrooms have non-slip floors and grab bars. Utensils and dishware are in good repair and ready for client use. The knives and sharp objects were locked in a cabinet in the kitchen. The water temperature was measured by LPA, the thermometer read at 109 degrees F. There is adequate seating in the common areas. Resident and staff files will be stored in a locked file cabinet. Medication will be stored in a locked cabinet in the kitchen. The facility will keep the detergents and cleaning chemicals in the locked laundry room. An adequate supply of clean linens and hygienic supplies for the residents were readily available at the facility. There are two (2) charged fire extinguishers in the facility. LPA observed operating smoke detectors and carbon monoxide alarms in the facility. LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, and personal rights. The facility was equipped with a complete first aid kit and manual. LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA has determined that the facility met the operational requirements for licensure. The Pre-licensing inspection is complete. The facility has satisfied all requirements in accordance with Title 22 California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Alan Nakamura.the state’s words, verbatim · CDSS document, May 21, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Alan Nakamura (Managing Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On April 28, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 28, 2025