A Good Samaritan

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's)Toni Nwala and Tremayne Barra arrived unannounced to conduct an annual inspection. Upon arrival LPA's was greeted by facility staff and granted entry by Lungun Stumeany. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began- Four (4) 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. 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 109.6 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. 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 the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA began review of employee records- Four (4) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current Licensee certification; expires 02/06/2027. CPR and requirements have been met. LPA made observation 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 remains unchanged. Smoke detectors and carbon monoxide detectors were tested and are operational. Fire extinguishers are tested or replaced annually and were last done so on 06/19/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 1/26/2026. Based on the information received during this visit today, zero (0) deficiencies are not being cited per Title 22, Division 6 of The California Code of Regulations. This LIC809 Report was reviewed with and a copy provided to the facility representative at the time of the exit interview.the state’s words, verbatim · CDSS document, Feb 18, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the facility. The LPA was allowed entrance and met with Licensee Representative, Salote Tupou, and Administrator, Vaiasani Tupou. The LPA informed the Licensee and Administrator of the purpose for the visit. The inspection included the following: Food Service: The LPA inspected the facility's kitchen areas and food supply. The LPA observed all food to be of good quality. All readily perishable foods and beverages capable of supporting rapid and progressive growth of micro-organisms were stored in covered containers at appropriate temperatures. Soaps, detergents, cleaning compounds and similar substances were stored in areas separate from food supplies. All kitchen areas were kept clean and free of litter, rodents, vermin, and insects. Staff were observed to be meeting resident's modified diets. Physical Plant: The facility consists of three (3) resident bedrooms, one (1) meeting room/office, one (1) staff room, three (3) bathrooms, a kitchen and dinning area, a living room, a yard with sufficient seating and space for activities, and an Accessary Dwelling Unit (ADU). There are no bodies of water located on the property. According to Licensee Tupou, there are no weapons stored at the facility. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways were kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet and shower used by residents. Resident showers have slip resistant mats present. Smoke detectors and carbon monoxide devices were tested and were observed to be in operating condition. The facility was kept exceptionally clean, organized and free of any odors. Record Review: All staff were observed to have appropriate fingerprint clearances; however, one uncleared adult was observed to be residing in the ADU on the property. According to Licensee Tupou, the individual was a renter and had not been fingerprint cleared. A citation and civil penalty will be issued. Staff responsible for direct care and supervision have current First Aid and CPR training. Training on dementia care and medication administration has been completed. The licensee appears to be operating the facility within the conditions specified on the license. The facility currently has an approved Hospice Waiver for one (1) resident; and there are currently no residents in care receiving hospice services. There is an emergency disaster plan in place. Proof of emergency drills was observed on file. The licensee (TUPOU FAMILY, INC) is a current and active corporation. The LPA observed current liability insurance on file. Medication Review: The LPA inspected resident medications. Medications were observed to be well organize and inaccessible to unauthorized individuals. Centrally stored medication destruction records were observed on file. Licensee Tupou agreed to provide the LPA with a copy of the current liability insurance, staff schedule, a resident roster, and a plan on how the ADU will be utilized in the future, along with any supportive documents. Licensee Tupou confirmed she did decide to retract the capacity increase for non-ambulatory residents, which originally included the use of the ADU for the facility. An exit interview was conducted with the Licensee and Administrator, in which this report was reviewed, and a copy was provided, along with appeal rights and other supportive records.the state’s words, verbatim · CDSS document, Jan 14, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection to the facility. The LPA was allowed entrance into the facility and met with Licensee, Salote Tupou, and Administrator, Vaiasini Tupou. The LPA informed the Licensee and Administrator of the purpose for the visit. The facility currently has an approved Hospice Waiver for one (1) residents. The inspection included the following: Physical Plant: The facility consists of three (3) resident bedrooms, one staff room, a dinning area, a living space, an open kitchen, and an outdoor and patio space, with sufficient seating and space for activities. There are no bodies of water located on the property. According to Licensee Tupou, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats present. The carbon monoxide and smoke detectors were tested by the Administrator and were observed to be in operating condition. The home was kept exceptionally clean and free of any odors. Food Service: There is a minimum of 2 days of perishable foods and 1 week's supply of non-perishable foods. Sufficient supplies were observed to be available for resident use. Record Review: All staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Staff responsible for direct care and supervision have current first aid and CPR training. Dementia care training was observed to be available and complete. The facility was not operating beyond the conditions specified on the license. The LPA was informed by Administrator Vaiasini that there are currently no resident in care who are receiving hospice services services. There is a disaster and mass casualty plan in place. Proof of emergency drills were observed on file. Facility records were kept well organized. Medication Review: The LPA reviewed medications for two residents. The LPA observed four medications found not to be labeled. The medications were being centrally stored for Resident Two (R2). All four medications were listed on R2's medication list. This violation poses a potential health, safety and personal rights risk to the resident in care. A citation will be issued. An exit interview was conducted with Licensee Salote Tupou, in which this report was reviewed and a copy was provided, along with the LIC 811 and instructions on appeal rights.the state’s words, verbatim · CDSS document, Apr 5, 2024