Ambrosia Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Helen Ibrahim. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 4 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 108 degrees F in resident bathrooms. Fire extinguisher was serviced in March 27, 2026. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 8/20/2026. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. A technical violation was cited during today's visit. This report was reviewed with Administrator Helen Ibrahim and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Sep 23, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Helen Ibrahim. During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 4 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 116 degrees F in resident bathrooms. Fire extinguisher was serviced in March 14, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 27, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. No deficiencies cited during today's visit. This report was reviewed with Administrator Helen Ibrahim and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2025

Allegation investigated: A resident had a fall who sustained a fracture due to neglect/lack of supervision.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint investigation to deliver the findings on the above allegations. LPA met with Administrator Helen Ibrahim. On September 27, 2024, the Department received a complaint alleging A resident had a fall, who sustained a fracture due to neglect/lack of supervision. It has also been alleged that R1 had sustained a fall on September 22, 2024, resulting in a fracture. Page 1 Out of 3. Unfounded On October 3, 2024, Licensing Program Analyst Manuel Monter interviewed ADM. ADM stated she was at the facility on September 22, 2024 and R1 had not sustained a fall in the facility. ADM stated she was informed by R1’s Power of Attorney (POA )on September 24, 2024, after R1 was taken to the hospital, that he/she took R1 out on an outing, on September 21, 2024, and R1 had hit his/her hand on the wheel chair. R1's POA stated R1 had stated "Oww", but stated to the POA that he/she was not experiencing pain. POA stated he/she did not inform the facility staff about R1 hitting his/her hand on the wheel chair. Licensing Program Analyst Manuel Monter interviewed Staff S1 & S2. S1 stated he/she is a live in staff who resides in the staff room, directly next to R1’s bedroom. Staff S1 and S2 stated stated R1 didn’t have a fall in the facility. S1 and S2 stated they didn’t observe R1 sustaining a fall and did not find R1 on the ground. Licensing Program Analyst Manuel Monter interviewed residents R1-R6. R1 stated R1 stated he/she did sustain a fall back in March 2023, in the hospital. R1 stated he/she has not fallen in the facility. R1 stated he/she did hit his/her hand when he/she went with his/her family member to the park. LPA Monter interviewed 6 residents (R1-R6). 5 Out of 6 residents interviewed (R2-R5) stated they did not observe R1 sustain a fall in the facility on September 22, 2024. 1 Out of 6 residents interviewed (R6), is nonverbal and was unable to respond to LPA’s questions. On November 12, 2024, LPA Manuel Monter interviewed R1’s Power of Attorney (POA). POA stated he/she was out with R1 on September 21, 2024, at a park. POA stated he/she was pushing R1 on wheelchair. POA stated he/she heard R1 say “ow”. R1 told POA that he/she banged his/her hand on the wheel of the wheelchair. POA asked R1 if he/she was ok. R1 stated he/she was not in pain. POA said he/she didn’t tell the staff, cause R1 stated he/she was fine. POA stated then after a few days he/she was informed that R1 went to emergency due to pain on finger. POA stated R1 had a minor fracture on his/her pinky finger, which required a cast to be used for a couple weeks. POA stated R1 didn’t have a fall in the home. POA stated R1 just banged his/her hand on the wheelchair. Page 2 Out of 3. Based on a review of Facility Incident Report, dated October 3, 2024, emergency services were contacted for R1 on September 24, 2024, who stated he/she had fallen. Based on a Review of R1’s Kaiser Permanente Progress Notes, dated October 20, 2024, R1 had injured his/her finger when he/she was out in the park with his/her family member on September 21, 2024. R1 hit his/her hand against the wheelchair armrest and R1 yelled “ouch.” The results of the X ray, state there was no acute fracture or dislocation. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 3 Out of 3. END OF REPORT. Licensing Program Analyst Manuel Monter interviewed resident R1. R1 stated he/she did hit her hand when he/she went with his/her family member and had hit her hand on the wheelchair when they were visiting the park. On November 12, 2024, LPA Manuel Monter interviewed R1’s Power of Attorney (POA). POA stated he/she was out with R1 on September 21, 2024, at a park. POA stated he/she was pushing R1 on wheelchair. POA stated he/she heard R1 say “ow”. R1 told POA that he/she banged his/her hand on the wheel of the wheelchair. POA asked R1 if he/she was ok. R1 stated he/she was not in pain. POA said he/she didn’t tell the staff, cause R1 stated he/she was fine. Based on a Review of R1’s Kaiser Permanente Progress Notes, dated October 20, 2024, R1 had injured his/her finger when he/she was out in the park with his/her family member on September 21, 2024. R1 hit her hand against the wheelchair armrest and R1 yelled “ouch.” The results of the X ray, state there was no acute fracture or dislocation. Based on a review of facility Fax receipt, the facility sent a fax to CCL on September 25, 2024, at 4:32pm, which contained 2 pages. Furthermore, the fax receipt states the result of the fax was “ok.’ Based on a review of CCL fax records, the fax in question was not received. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Page 2 Out of 2. END OF REPORTthe state’s words, verbatim · CDSS document, Nov 21, 2024 · control 26-AS-20240927165935

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Helen Ibrahim . During the visit, LPA observed 6 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 4 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 116 degrees F in resident bathrooms. Fire extinguisher was serviced in May 6, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 18, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff and 2 residents. Page 1 Out of 2. LPA requested the following documents be sent to the Department by October 10, 2024. ADM stated she will send the following documents; 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) 6. Please submit copy of surety bond (if Applicable) 7. LIC309 Administrative Organization 8. LIC610E, Emergency Disaster Plan for Residential Care Facilities for the Elderly. 9. LIC9020, Register of Facility Clients/ Residents No deficiencies cited during today's visit. This report was reviewed with Administrator Helen Ibrahim and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Oct 3, 2024