Adonai Cares for Elderly

Type of visit: Required - 1 Year

On November 18, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a required annual inspection utilizing the inspection tool. LPA met with Administrator and explained the purpose of the visit. Today's inspection, LPA and Administrator conducted a tour of the interior of the facility to ensure the health and safety of residents in care. LPA observed facility to have the requires Community Care Licensing compliance poster and Long Term Care Ombudsman poster in the common area. LPA observed facility to have ample supply of perishable and nonperishable foods for residents in care. LPA observed a locked space designated for sharps in the kitchen. LPA observed a locked and secure space for medications. LPA observed residents bedrooms to be free of dangerous items. LPA observed laundry room to be locked which toxins are additionally stored within. Fire extinguishers present throughout the facility with service date of November 26, 2024. LPA was informed inspection has been scheduled for later this month. Facility was in a comfortable heating temperature of 74*F. In areas observed, no immediate health, safety and/or personal rights violation observed. File review was conducted for residents records and personnel records. LPA conducted a file review of facility's Emergency Disaster Plan, LPA informed Administrator that a new plan does not need to be generated if there are no changes, Administrator is to sign off the plan as "reviewed" on Page 9. In records reviewed, no deficiencies cited. LPA provided Administrator a copy of 87412 Personnel Records. Additionally, LPA will reach out to Admin Cert Unit for an active copy of Administrator's Certificate. A copy of liability insurance was obtained. CARE tool was completed with Administrator and found facility to be in substantial compliance. No deficiencies cited. Exit interview and a copy of the report provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

Allegation investigated: Staff did not administer resident's medications as prescribed.

Amend to make 'Public'- On October 1, 2024, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to deliver complaint findings for complaint # 59-AS- 20240827132621. LPA met with Ola Samual, Administrator/Licensee, and informed her the reason for the visit. The Department received a complaint alleging the facility staff did not administer resident's medications as prescribed. LPA reviewed resident files and conducted interviews with residents and staff. LPA also obtained schedules and other documentation. LPA interviewed 2 staff and 1 resident. Licensee stated she accepted the resident that came from another facility in which the resident was taking a narcotics for relief of pain. Licensee states when she went to get a refill for the resident, the doctor would not refill the order of medication until the resident saw a local physician. Licensee was not able to have the prescription filled. To continue see 9099-C... Unfounded 9099-C... In an interview with the resident, the resident confirmed that the emergency room physician would not refill the prescription until the resident saw a primary care physician. The resident has since moved out of the facility. This agency has investigated the complaint alleging the facility staff did not administer resident’s medication as prescribed. Based on LPA's observations and interviews which were conducted and recorded, we have found that the complaint was unfounded, meaning, the allegation was false, could not have happened and/or is without a reasonable basis. Allegation unfounded. Per California Code of Regulations, Title 22, no citations were issued. An exit interview was conducted, and a copy of this report was given to Ola.the state’s words, verbatim · CDSS document, Oct 1, 2024 · control 59-AS-20240827132621

Type of visit: Required - 1 Year

On October 1, 2024 at Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived unannounced to conducted an Annual Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lyons met with Ola Samuels, Licensee, who assisted LPA in today’s inspection. The Administrator certificate expires 12/13/2024. The current census is 4 The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 67 degrees F. This is a one story home with 4 bedrooms and 3 bathrooms. LPA inspected the interior and the exterior of the facility including the common living spaces, the resident bedrooms and bathrooms and kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperatures were taken and measured at 105 degrees F. There’s appropriate lighting throughout the home. Living rooms, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are 4 Bedrooms. All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. The sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies were inaccessible. To continue see 809-C... First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use. LPA inspected the exterior grounds of this facility. LPA toured the exterior grounds. There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and potential hazards There’s a drawer for resident’s medication. Medication cabinet was locked. The facility Medication Administration Record was reviewed as well as the dispensing log. All current and up to date. LPA reviewed 2 resident files and 1 staff files. Resident's Records reviewed indicated emergency contacts, Assessments, Admission Agreements and Physician's Reports were all current and up to date. Staff records reviewed revealed current First Aid & CPR certificates, Health Screenings, Emergency Contacts, Criminal Record Clearances were all up to date and the facility is conducting staff training as required. File review reveals all documents are in the regional facility file. LPA and Ola conducted the Inspection Tool with no issues or concerns. The facility has had 2 residents with Covid-19 since the last annual inspection. The licensee is following her Infection Control Plan as required. In the areas that were evaluated, no deficiencies were observed. The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file. Administrator shall submit the listed documents to Licensingno later than November 1, 2024. Licensee submitted the document at this visit, An exit interview was conducted and a copy of this report was given to Ola.the state’s words, verbatim · CDSS document, Oct 1, 2024

Allegation investigated: Staff increased resident rent with a proper notice Untrained staff Staff overcharged resident

On May 7, 2024, Licensing Program Analyst (LPA), DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint # 59-AS-20240110112043. Met with Ola Samuels, administrator/licensee, and informed her the reason for the visit. Sacramento North Regional Office received a complaint alleging staff increased resident rent without prior notice, untrained staff and staff overcharged resident. Based on interviews and records reviewed, the facility increased R1’s monthly rate from $4,000 to $6,000 without cause. According to R1’s Admission Agreement, it was agreed between the license and R1 that R1’s monthly fee would be $4,000 a month. In October 2023, the licensee provided R1 a notice indicating R1 needed a higher level of care than what the facility could provide. Upon issuing the notice, the licensee increased R1’s monthly fee to $6,000 a month effective December 1, 2023. To continue see 9099-C... Substantiated 9099-C... Based on a review of R1's records, R1 did not have a change in condition between the time R1 was admitted to the facility and when R1 received the notice of the increase. Additionally, R1 indicated they felt pressured to sign the admission agreement modification as R1 made the licensee at the time R1 was admitted that they were unable to pay more than $4,000 a month. The licensee did not supply adequate reasoning for the increase based on R1's change in condition therefore the increase was unlawful. Interviews indicated that S1 was assigned to assist R1 with transferring. It was reported that on two different occasions, S1 dropped R1 while transferring from the bed to the wheelchair and from the wheelchair to the bed. Interviews indicated that incident occurred because S1 was not trained on proper transferring. Additionally, a review of S1's file indicated no training documentation. After R1's second fall, S1 was terminated from her employment at the facility. On December 18, 2023, R1 went to the hospital for knee surgery and never returned to the facility. R1 was admitted to another facility from the hospital beginning January 1, 2024. From January 1, 2024 to January 2, 2024, the licensee charged R1 a fee of $1,000 a day until RP came to pick up personal belongings. Based on a review of the admission agreement signed on by both the licensee and R1, there is no language that permits the licensee to charge R1 this fee. Based on LPA's observations and interviews which were conducted and recorded, the preponderance of evidence standards has been met, therefore, the allegations that staff increased resident rent with a proper notice, untrained staff, and staff overcharged resident to be SUBSTANTIATED. Plan Of Correction for overcharging – repay the money to the resident and provide proof of payment. Deficiencies are being cited on D Page. To continue see 9099-D...the state’s words, verbatim · CDSS document, May 7, 2024 · control 59-AS-20240110112043

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: May 7, 2024

87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This was not done by facility intimidating R1 into signing an admission agreement modification for a rent increase.the state’s words, verbatim · CDSS document, May 7, 2024

Plan of correction: Licensee shall write on how it is important to be accorded dignity in personal relationships with staff, residents and other people. Shall be submitted no LPA no later than June 7, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411 · Plan of correction due date: May 7, 2024

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs… The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.This was not done by having 1 staff working at the time of the incident.the state’s words, verbatim · CDSS document, May 7, 2024

Plan of correction: Licensee shall have facility personnel at all times to be sufficient in numbers and competent to provide the services necessary to meet residents needs.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Talwinder Bains arrived on 11/20/23 to conduct the Post Licensing inspection. LPA met with administrator, Olawumi Samuels who assisted LPA during today's inspection. No deficiencies were observed or cited during today's visit. See LIC809 for Annual Inspection report for 11/20/23 for details. Exit interview conducted. A copy of this report was printed and given to Administrator.the state’s words, verbatim · CDSS document, Nov 20, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 11/20/23 to conduct the annual inspection. LPA met with administrator, Olawumi Samuels who assisted LPA during today's inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed residents (2) and staff files (1). All residents files contained the required paperwork. Staff file contained the required paperwork. Staff have current first aid and CPR training. Facility was clean. All required postings were observed. LPA reviewed medications of 2 residents comparing with physician orders and find no errors. LPA and Administrator toured the facility together to ensure the health and safety of residents in care. The areas toured included residents rooms, bathrooms, kitchen,office area, common areas, garage and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. All exits were unobstructed. The administrator's certificate is current. There is a gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use . Water temperature is within compliance (116 degree F) .Inside temperature was observed to be 80 degree F. In the areas toured, there were no health or safety violations were observed. No deficiencies were observed or cited during today's visit. Exit interview conducted. A copy of this report was printed and given to Administrator.the state’s words, verbatim · CDSS document, Nov 20, 2023