Ak and David Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. Mary Jean Catacutan, Administrator arrive shortly after and met with LPA. There are six residents at the facility and there are three residents receiving hospice services currently. LPA accompanied with Administrator began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage located in the garage in a spare refrigerator. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. Medication cross checked for accuracy of date and dosage. LPA inspected the bathroom and LPA measured the hot water temperature which measured 112.6 Fahrenheit degrees in all facility bathrooms. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in storage cabinet in the garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has Continued on LIC809-C sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Carbon monoxide and smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there is several shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of February 03, 2026, mounted in the kitchen wall. LPA reviewed and verified fire drill logs; LPA verified the last drill was conducted was January 8, 2026. Facility has a second floor which is inaccessible to residents in care, access to the second floor is by the door to the garage. There are no residents residing on the second floor of the facility. LPA verified resident in care do not have access to the second floor. LPA began review of records. LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated with the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 16, 2026

Allegation investigated: Staff physically restrained resident Facility accessing resident funds without consent

Licensing Program Analyst (LPA) Celine Rodriguez initiated an unannounced 10-day visit to the facility for the complaint and delivered the findings. LPA Rodriguez explained the purpose of today's visit, was greeted, and granted entry by staff on duty. For this visit, LPA Rodriguez met with facility administrator (AD) Mary Jean Catacutan. During the investigation, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. It was alleged that staff physically restrained resident. 5 out of 5 resident interviews did not corroborate with the allegation by denying of staff restraining resident and reporting that staff are "good" and "nice". LPA conducted an interview with resident 1 (R1) who denied of being restrained. 3 out of 3 staff interviews did not corroborate with the allegation by stating that staff do not restrain residents. Unfounded Per documentation review, resident (R1) had a neck fracture prior to admission into the facility and wore a neck brace, and despite R1 experiencing pain, R1 declined in wanting to take medications prescribed by R1's doctor, to which R1 confirmed this to be true. On 10/28/25, R1 was sent to the hospital due to abdominal pain, however voluntarily declined in wanting to return back to the facility. It was alleged that facility is accessing resident funds without consent. 5 out of 5 resident interviews did not corroborate with the allegation by stating that either they, or their families have access to their funds, and that their financial information is not provided to the facility staff. LPA conducted an interview with R1 who denied of staff accessing funds by confirming that no information was ever provided to staff regarding R1's funds and that R1 only had access to own funds. 3 out of 3 staff interviews did not corroborate with the allegation by stating that facility does not handle resident funds. Per record review, LPA verified that facility does not safeguard resident's financial funds. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, these allegations are UNFOUNDED, meaning that these allegations wer false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with AD Catacutan. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Nov 10, 2025 · control 22-AS-20251103084921

Allegation investigated: Resident sustained a fracture due to lack of care from staff Staff spoke inappropriately to resident Staff did not ensure that resident was adequately fed Staff threw objects at resident Staff handled resident in a rough manner Staff did not seek medical attention for resident in a timely manner Staff interfered with resident visits Staff video recorded resident without consent

On May 13, 2025, Licensing Program Analyst (LPA) Cassandra Mikkelson contacted the Administrator via phone to deliver final findings regarding a complaint that was received on 02/16//2024. LPA Mikkelson spoke with ***, Administrator, and explained the purpose of the call. During the investigation, the Department conducted multiple interviews and reviewed extensive documentation. The results of the investigation are as follows: **Continued on 9099-C page** Unsubstantiated Resident sustained a fracture due to lack of care from staff Interviews conducted and records reviewed indicated that Resident R1 did not sustain any fractures or head injuries after the fall that occurring on 02/15/2024. Interviews with staff indicated that staff were present and were able to assist R1 during fall. Hospital records indicated that R1 did not have any injuries or fractures, but a sling was requested due to bruising and pain in arm from fall. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Staff spoke inappropriately to resident Interviews conducted indicated that staff speak appropriately to residents in care. Staff do not yell or talk inappropriately to residents in care. Interviews with residents indicate that staff are kind and there are no complaints regarding staff. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Staff did not ensure that resident was adequately fed Interviews conducted indicated that residents are adequately fed at the facility. Residents are able to eat breakfast, lunch and dinner with snacks as needed. Interviews with residents in care indicated that there is plenty to eat and a good variety of foods and meals to choose from. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Staff threw objects at resident Interviews conducted indicated that staff do not throw objects at residents in care. Interviews with residents indicated that they were not aware of any objects being thrown at the facility. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. **Continued on 9099-C2 page** Staff handled resident in a rough manner Interviews conducted indicated that staff do not handle residents in a rough manner. Interviews with residents indicated that staff are kind. Interviews with staff indicated that staff are properly trained on handling or transferring residents. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Staff did not seek medical attention for resident in a timely manner Interviews conducted indicated that R1 went to the hospital frequently due to pain. Interviews with staff indicated that facility Administrator was the person who would take R1 to the hospital or doctors appointments. Staff called 9-1-1 at the request of R1 based on R1’s care needs or if any injuries occurred. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Staff interfered with resident visits Interviews with residents indicated that staff did not interfere with resident visits. Staff respected each resident’s wishes and would assist with visitors that came. Interviews with staff indicated that they only turned away visitors at the request of the resident themselves. Resident R1 would sometimes request to not have any visitors as it overwhelmed R1 at times. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Staff video recorded resident without consent Interviews with residents indicated that there were no cameras in resident rooms other than Resident R1. R1 had a camera in their room per their response party’s request. Interviews with staff indicated that they were aware of the camera, but it only was a video feed, no audio was allowed. Staff indicated that R1 was aware of the video camera in their room and had consented to having it there. Based on records reviewed and interviews conducted, there is insufficient evidence to corroborate the allegation. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.the state’s words, verbatim · CDSS document, May 13, 2025 · control 22-AS-20240216162152

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Mary Jean Catacutan was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Mary Jean Catacutan has a valid Administrator certificate which expires on August 2, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for three. The facility is a two story home with five resident bedrooms, all of which are located on the first floor, two staff bedrooms, both are which are located on the second floor, three resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, one of which is on hospice, and two care giving staff present. LPA observed residents relaxing in the living room and in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the dining room. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA tested the signal system in each of the resident bedrooms which tested operational. LPA inspected the three resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 105.8 and 110.6 degrees Fahrenheit. LPA observed the second floor to be for staff use only and off limits to residents in care. LPA observed staff bedrooms to be clear of hazards. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C The four burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. A fire extinguishers is located in the entryway of the facility and it was observed to be charged and serviced as of February 6, 2025. LPA tested the individual smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 18, 2025. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit was observed be stored in the locked kitchen cabinet and it was observed to have all the required components. LPA observed a fire place in the living room and it was observed to not be in operation at the time of visit. The door leading to the attached two car garage is kept locked and inaccessible to residents. The garage is used for storage and laundry. LPA observed chemicals and toxins to be stored in the locked two car garage. LPA observed additional linens and blankets to be stored in the garage. LPA observed the facility has a three day emergency food and water supply to be stored in the garage. LPA and the AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side of the facility is self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed all five residents’ medication and medication records. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on today's observations, no deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Mary Jean Catacutan and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 10, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection. LPA De Perio explained reason for visit and was greeted and granted entry by facility administrator (AD) Mary Jean Catacutan. For this visit, LPA observed 5 residents in care, of which 3 are on hospice, and 3 staff members on duty. LPA observed the Administrator's Certificate for Mary Jean Catacutan, which expires on 8/2/25. PUB475 "See Something, Say Something" poster was also observed to be posted in the kitchen. LPA De Perio toured the interior and exterior portions of the facility with AD Catacutan. The facility is a two level structure and is licensed for 6 non-ambulatory residents, of which 3 may be on hospice. On the first floor, there are a total of 5 bedrooms, of which 4 are private resident rooms and 1 shared resident room. On the second floor, there are 2 bedrooms designated for staff. LPA observed and verified that there are no residents residing on the second floor. LPA De Perio toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 3 bathrooms on the first floor for resident use, and 1 bathroom on the second floor designated for staff. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 113.1 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the hallway. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPA De Perio observed that First Aid Kit had all the required components. Medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which both were self-closing and self-latching. No bodies of water were observed. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. An exit interview was conducted with AD Catacutan. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Mar 23, 2024