Amani Homes

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Case Management - Incident

At approximately 2:00PM, Licensing Program Analyst Contreras arrived unannounced to conduct a case management visit for an incident that was self-reported by facility. From 12/25/25-12/30/2025 Resident (R1) was admitted to emergency hospital for vomiting. R1 was under observation in Kaiser Vacaville. R1 was sent home on 12/30/25. On 1/01/2026 R1 returned to the hospital for change of condition again due to refusing to eat and take medications. After visit summary showed R1 was diagnosed with dehydration. R1 had appointment with PCP for observation. R1 has not experienced any other changes of condition since returning back from the hospital. Admin discussed with LPA after visit summary from Hospital and copy retrieved for file. Facility admin has discussed a plan with staff to prevent dehydration from occurring and changes of condition of resident. No deficiencies cited during todays visit.the state’s words, verbatim · CDSS document, Jan 22, 2026

Type of visit: Required - 1 Year

At approximately 10:15am, Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by facility administrator (admin) Josephine Kamau. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for 4 ambulatory of which 4 may be non-ambulatory. Facility has approved hospice waiver for 4 residents. Facility has 4 rooms and 2 restrooms accessible for residents. LPA toured the building and grounds which was found to be clean and in good repair. Facility was clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 3/13/25. Fire alarms and carbon monoxide detector were tested and operational. All signal alarms throughout facility were operational and functional. Outdoor emergency exit clear from obstruction. Facility has outdoor sun room and backyard furniture accessible to residents. Facility's telephone was tested and was operational. All bedrooms were equipped with lighting, a night stand and chest of drawers. All bedrooms were clean and in good repair. Resident bathroom had required bath mat and grab bar. Facility had an ample supply of linens and towels. LPA observed the 2 day supply of perishable food requirement and 7 days supply of non-perishable foods per Title 22 Regulations. Multiple food items found to be expired in pantry including granola bar box, cake mix and frosting box and canned goods (Deficiency cited, see 809D). Toxins are stored in a locked in garage. Sharps and knives were locked in lock box. Facility had emergency food and water for 72 hours. Water temperature measured at 114.3 and 113 degrees F at faucets accessible to residents which is within the allowable range of 105 to 120 degrees F. Disaster drills are conducted quarterly. Continued onto 809-C... continued from 809C.... LPA reviewed 4 of 4 resident records. All required documentation was present. Physician reports were up to date. LPA reviewed 4 staff records. All documentation found up to date. Facility handle resident money through bank account, no cash on site. LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308-Designation of Responsibility Liability Insurance Surety Bond- (Retrieved during visit) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Report read with administrator, Copy of report given.the state’s words, verbatim · CDSS document, Oct 14, 2025

Type of visit: Case Management - Incident

At approximately 9:35PM, Licensing Program Analysts (LPAs) Felias and Contreras arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Josephine Kamau.The purpose of the visit was to follow up on an incident report that was self-submitted to Community Care Licensing (CCL). Incident Report 1: On 4/07/25 CCL received an incident report. Per report, on 4/06/2025, a medication audit was completed and discovered that Resident 1 (R1) morning medication was not administered on 4/04/25 and 4/05/25. Report stated that facility monitored R1 for adverse effects. R1 was found to be in good health. Facility made all appropriate notifications per regulation. Per discussion with Administrator, Staff Member 1 (S1) received additional medication administration training. Copy of training obtained during visit. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. **Deficiency cited today, 04/15/2025, has been cleared during visit. Plan of Corrections Letter provided. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Confidential Names (LIC811), Plan of Corrections, Plan of Corrections Letter, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 16, 2025

87465 Incidental Medical and Dental Care:(a) (a) A plan for incidental medical and dental care shall be developed...(4)The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: based on record review, licensee did not comply with the section cited above. Per Incident report, licensee did not ensure R1's medication was administered correctly. This is an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2025

Plan of correction: Licensee showed proof of completed medication training for identified staff member. Copy of training obtained during visit. Deficency cleared during visit

Type of visit: Required - 1 Year

At approximately 10:15 AM, Licensing Program Analysts (LPAs) Julie Florio and Robert Frank arrived unannounced to conduct a required 1-year annual inspection and were greeted by Staff 1 (S1) and Staff 2 (S2). Administrator, Josephine Kamau was contacted and arrived at approximately 10:45 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. All residents were present during today's inspection. Facility has a hospice waiver for four (4) and is approved for all non-ambulatory residents. Facility is vendorized with the North Bay Regional Center (NBRC). At approximately 10:50 AM, LPAs initiated a tour of the facility with Administrator and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in Residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPAs observed a supply of hygiene products, clean linens, paper products, and incontinent care briefs available to residents. LPAs advised Administrator to ensure that all trash cans in the facility are covered to remain in compliance with regulation. Residents' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. LPAs observed cabinets containing cleaning supplies (Clorox bleach powder, Lysol, detergents, carpet and floor cleaner, etc.) and other items that could pose a risk (knives, medications) with the magnet and keys used to unlock them stored accessible to residents in care, (see LIC809D). Administrator secured the magnets and keys immediately and installed additional locks bringing the facility into compliance. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a sun room and backyard space for activities. LPAs observed craft supplies and games for residents in care. Each resident has an internet access device and facility has internet available. Facility's telephone was tested and was operational. Continued on LIC809-C... Continued from LIC809... Facility's fire extinguisher was observed charged and was last serviced 2/2024. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts quarterly disaster drills with the most recent drill conducted 9/2024. LPAs observed facility's infection control plan and emergency disaster plan which was last updated 7/2023. LPAs observed a supply of PPE, emergency supplies, a first aid kit, flashlights and backpacks for each resident for emergency preparedness. Administrator provided LPAs with a copy of the facility's current liability insurance. At approximately 11:50 AM, LPAs reviewed three (3) staff files and three (3) resident files. Three (3) of three (3) staff files reviewed have all of the required paperwork and proof of current First Aid and CPR training. However, LPAs advised Administrator to ensure that proof of all completed staff training is maintained on site to remain in compliance. Three (3) of three (3) resident files reviewed have all the required paperwork. Administrator coordinates medical and dental visits for the residents and transportation to and from their appointments. At approximately 2:00 PM, LPAs reviewed medications, and medication records which were observed not maintained in compliance with regulation, (see LIC809D). P&I is maintained in compliance with regulation. However, LPAs advised Administrator to increase their bond amount to bring the facility back into compliance with regulation. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Report (updated) Bond (updated) LIC610D Emergency Disaster Plan (updated) LIC308 Designation of Responsible Party continued on LIC809C... continued from LIC809C... Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights were given. Exit interview conducted with Administrator whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Dec 12, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.