Alondra Guest Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff Joel Ros. Administrator Iwona Kaya arrived later. The following was observed during the inspection: Infection Control: The facility has an Infection Control Plan that is reviewed annually. Operational Requirements: A Dementia and hospice waiver for 4 residents has been approved. A fire clearance for 6 non-ambulatory adults 60 and over. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate expires 3/8/2027 Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents. The facility consists of a kitchen, dining room, family room, living room, one live-in staff bedroom, four (4) resident bedrooms, laundry room, and detached garage. The facility has a fire extinguisher. Rooms are equipped with required furniture and bedding. Cleaning supplies and toxic substances are inaccessible to residents. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The building contains central air conditioning and heating. First aid kits/Manuals are kept in activity rooms; consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Exit doors are free of any obstruction. The last Emergency Disaster drill was conducted. "Smoke and carbon monoxide detectors were tested. Room #1's smoke detector is not properly installed and was observed hanging by wires. Staffing: A total 5 staff members provide care and supervision to the residents. Personnel Records/Staff Training: Six files were reviewed. Files were reviewed for criminal background clearance, training, health clearance, and 1st Aid/CPR training. Note: Staff (S3) had expired 1st Aid/CPR training. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. However, resident files did not have current reappraisals and Residents (R2 & R3's) Medical Assessments are more than twelve months. RCFE complaint poster and Personal rights were observed posted. However, the RCFE complaint poster is not the correct size i.e., 20 x 24. A Technical Advisory was issued. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. One resident has a modified diet. Incident Medical and Dental: Centrally Stored Medication And Destruction Record/ 30-Day supply of medications were reviewed. Medical and dental transportation is provided by family. The facility does not use MAR's. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: Two residents are enrolled hospice services and three (3) residents receive home health services. Pursuant to Title 22, deficiencies were cited. An exit interview was conducted with Iwana Kaya. A copy of the report/appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Ronna Alabi, caregiver for the facility, and explained the purpose of the visit. Administrator Iwona Kaya arrived shortly thereafter. There are six (6) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all six (6) of whom may be non-ambulatory and four (4) of whom receive hospice services. The facility consists of a kitchen, a dining room, a living room, a laundry room, a staff bedroom, four (4) resident bedrooms, a bathroom which had a hot water temperature reading of 105.2 Degrees Fahrenheit, and a detached garage that has the facility’s emergency food supply. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has a fully charged fire extinguisher kept in the facility. Operational Requirements: · The Program Design was reviewed. · Care and supervision to meet the clients’ needs was observed. Staffing: · Five (5) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All Five (5) staff records reviewed have a health screening with a Tuberculosis clearance, and five (5) staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 8/15/2027. Resident Rights/Information: · Physician orders were reviewed for six (6) resident files. · Medications were also reviewed for six (6) residents. Resident Records/Incident Reports: · Six (6) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. · The last emergency and disaster drill was conducted on 9/2/2025. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview held and a copy of the report along was provided.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Sandy Lim, caregiver for the facility, and explained the purpose of the visit. Administrator Iwona Kaya arrived shortly thereafter. There are five (5) non-ambulatory residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) non-ambulatory residents, and also has a hospice waiver approved for three (3) residents. The facility consists of a kitchen, laundry room, two (2) living rooms, an office, a dining room, four (4) resident bedrooms, a backyard area with a detached garage that contains the facility's emergency food supply, and two (2) resident bathrooms of which Restroom #1 (R1) had a hot water temperature reading of 105.2 degrees Fahrenheit, and Restroom #2 measured at 105.6 degrees Fahrenheit. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has one (1) fully charged fire extinguishers in the facility. ·Water temperature readings for one of the bathrooms in the home did not fall within the required range of 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) non-ambulatory residents, and also has a hospice waiver approved for three (3) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · Six (6) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All staff records reviewed have health a health screening with a Tuberculosis clearance, and all staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 8/15/2025. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted and found within the facility. · The last emergency and disaster drill was conducted on 6/11/2024. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · There are five (5) residents who receive services from home health agencies, and the facility has the agreement with the home health agencies documented and on file. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 23, 2024

Allegation investigated: Staff do not keep the facility clean and sanitary. Staff did not ensure resident's hygiene needs were met.

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial visit to investigate the above allegations. LPA met with Sandy Lim/S-1 and discussed the purpose of today’s visit. Ywona Kaya (Facility Administrator) arrived at approximately 9:30 A.M. During this visit, LPA obtained a copy of the resident and staff rosters, reviewed files for R-1 through R-5 (R-1 through R-5) and obtained relevant documentation, interviewed Resident #1 (R-1), Resident #3 (R-3), Facility Administrator, Staff #1 (S-1) and Staff #2 (S-2). LPA was unable to interview Resident #2 (R-2) as R-2 was asleep during this visit. LPA was unable to interview Resident #4 (R-4) and Resident #5 (R-5) due to cognitive impairment. LPA also conducted a facility tour. Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Staff do not keep the facility clean and sanitary It is alleged that the facility is not kept clean or sanitary. Staff interviews revealed that this facility is kept cleaned and sanitary at all times. Interviewed staff indicated that they have not received any complaints in regards to this matter. LPA conducted a facility tour and observed the facility to be clean and sanitary (including tables used by residents during meal times). Resident interviews revealed that this facility is kept clean and sanitary. Interviewed resident indicated they do not have any concerns regarding this matter. Interviews and facility tour do not corroborate this allegation. Allegation: Staff did not ensure resident's hygiene needs were met. It is alleged that residents are malodorous and observed to be dirty. Staff interviews revealed staff meet resident’s hygiene needs. Interviewed staff indicated that they assist residents with their activities of daily living daily (including bathing). Interviewed staff indicated that they have not received any complaints in regards to this matter. LPA conducted a facility tour and observed the residents to be clean (including their clothing) and did not observed residents to be malodorous. Resident interviews revealed that staff meet their hygiene needs. Interviewed residents indicated they do not have any concerns regarding this matter. Interviews and facility tour do not corroborate this allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. Exit interview conducted, appeal rights and a copy of this report was provided to Ywona Kaya.the state’s words, verbatim · CDSS document, Aug 8, 2024 · control 28-AS-20240801114621

Allegation investigated: Staff left residents unattended. Staff are mismanaging residents medication. Staff did not keep a comfortable temperature for the residents in care. Staff are not providing adequate food service to residents.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Sandy Lin (caregiver) who allowed enterance to the facility, shortly after Administrator Iwona Kaya arrived to assist, the reason for the visit was explained. The investigation consisted of the following: LPA interviewed the 3 Staff (S1-S3), 4 Residents (R1-R4) and 1 Family Member of a resident that was visiting during investigation. LPA obtained copies of Resident and Staff Rosters, toured all resident rooms and tested each residents air conditioners in each room, checked facility theromostate to confirm temperature was within regulation, reviewed 5 residents medications, and checked food supply. (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff are not safeguarding resident's personal belongings. It is alleged that food items that were purchased for R1 are being eaten by staff or being consumed by people other than R1. LPA interviewed 3 staff and 2 out of 3 staff confirmed the above allegation and stated that a previous staff who is no longer employed at the facility (as of last week), would take food that was purchased by residents visitors and instead of giving the food solely to the intended person they would cut the food in half and giving one portion to the intended resident and the other half to another resident. LPA interviewed 4 residents and 2 out of 4 residents confirmed the above allegation and stated that their belongings have either gone missing or have been given to other residents. R1 stated that they do tend to share their snacks and food with others, however, on a few occasions food that was brought for them have gone missing. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 is being cited on the attached LIC 9099D. Exit interview held, a copy of this report and appeal rights was provided. The investigation revealed the following: Allegation: Staff left residents unattended. It is alleged that at approximately 1:30-2:30pm on Thursday August 1, 2024, S2 was observed to be sleeping during there shift and left residents unattended. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation. It was revealed during interviews that there are currently 3 live-in staff at the facility (one who is in training) and during the disclosed time is the time that staff take their staggered lunch breaks and residents were not left unattended as S3 was in the kitchen cleaning up after residents lunch hour. LPA interviewed 4 residents 3 out of 4 residents denied the allegation and stated they have not been left unattended at the facility and receive assistance promptly when needed. LPA interviewed 1 of the residents family members that was visiting during the investigation and they stated that they have never observed staff sleeping during their shifts and have never experienced staff leaving the residents unattended. Allegation: Staff are mismanaging residents medication. It is alleged that staff administered R1 the incorrect medication. LPA reviewed 5 residents medication with no issues observed, all medication was properly labeled and in their original containers. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated they are very careful when it comes to medication and have not made a mistake while administering medication. LPA interviewed 4 residents and 4 out of 4 denied the above allegation. Interview with R1, they stated that they are very much aware of the medication they take and what it looks like and have never been given the incorrect medication. LPA interviewed 1 of the residents family members that was visiting during the investigation and they stated that they have been present during medication administration and have never observed any issues. Allegation: Staff did not keep a comfortable temperature for the residents in care. It is alleged that the temperature in the facility is left at an uncomfortable temperature, reaching between 85-90 degrees F, and that the air conditioner is broken. LPA toured facility and observed thermostat in front living room to be at 85 degrees F (which is within the required rage of 68-85 degrees F). LPA observed fans in common areas to be operable. LPA toured each resident room and observed portable air conditioners in each room that were operable. Each resident room was also observed to be at a comfortable temperature. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that all residents air conditioners have been operable and the facility is maintained at a comfortable temperature at all times. LPA interviewed 4 residents and 4 out of 4 residents denied the above allegation. (Continued on LIC9099-C) Allegation: Staff are not providing adequate food service to residents. It is alleged that the facility does not provide residents with nutritious food and that the food is horrible. LPA toured kitchen and there was sufficient supply of perishable and non-perishable foods. LPA observed there to be fruits, vegetables, and a selection of different meats. Facility has a pantry and surplus of food in garage refrigerator. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that the facility maintains a sufficient about of food at all times with multiple items to choose from, as different residents have different preferences. LPA interviewed 4 residents and 4 out of 4 residents denied the above allegation and stated the food is good and staff are accommodating to their preferences. LPA interviewed 1 of the residents family members that was visiting during the investigation and they stated that their relative is well fed at the facility and the food is of good quality. Based on statements and interviews conducted with staff and residents, review of medications, review of food supply and LPA's observations during tour of facility, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2024 · control 28-AS-20240801110704

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80026(b) · Plan of correction due date: Aug 20, 2024

80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (b) If such a client is accepted for or maintained in care, his/her cash resources, personal property, and valuables not handled by a person outside the facility who has been designated by the client or his/her authorized representative shall be handled by the licensee or facility staff, and shall be safeguarded in accordance with the requirements specified in (c) through (n) below. This standard was not met as evidence by: Interviews with 3 staff 2 out of the 3 staff confirmed that a previous staff would (knowingly) take food inteneded for one resident and divide it to share with other residents without their permission. Interviews with 2 residents also confirmed this to be true.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: Administrator/Licensee to hold an in house training for all staff to be retrained in proper safeguading personal belongings of residents, which includes all belongings including food that is either purchaed with residents own funds or gifted to them. A copy of the training materials and training log with participants is to be provided to LPA via email by POC due date. tena.herrera@dss.ca.gov