Anl Facility Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elena Mallett conducted the required annual inspection. LPA arrived unannounced and met with Administrator Luzviminda Bulosan. The purpose for today’s visit was explained. The facility is licensed to serve 6 non-ambulatory elderly residents ages 60 and above. There is a hospice waiver for 2 residents. There are currently no bedridden residents and no residents are on hospice. There are currently 5 residents in care. The facility is a single-story home located in a residential area in Norwalk, Ca. A tour of the facility includes: living room, kitchen, dining area, 4 bedrooms (2 double and 2 single), 2 bathrooms (1 bathroom located in client room), front yard, back yard, detached garage and storage shed. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today’s visit and the initial visit and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Physical Plant & Environment Safety: LPA toured facility. The facility is well maintained and walkways and hallways are free of debris and obstruction. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The required furnishings, hygiene products, light and bed linens were observed. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested in both bathrooms, and measured within Title 22 requirements of 105F-122F. Shaded outdoor area for residents with a table and chairs. All storage areas for cleaning solutions, toxins, knives, sharps and hazardous items are kept locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance.Bathrooms contained grab bars and non slip floor mats in showers .The fire extinguisher was observed and was fully charged. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Appliances were observed to be operable and able to properly store and prepare food. Food is kept separate from cleaners, toxins and posions. A sample menu was provided. Disaster Preparedness: The facility has an updated Emergency Disaster Plan with contact numbers and at least 2 relocation sites and utility shut off points identified. Emergency food, water and a generator were observed. A full First Aid kit and Manual were available. Facility conducts monthly disaster drills. The most recent drill was on 04/20/2026. A copy of current Liability Insurance was provided. Due to time constraints the other Domains remaining in the CARE tool will be completed at a later date. No deficiencies were observed per Title 22 regulations during today's visit. Exit interview was held with Administrator Luzviminda Bulosan and a copy of this Licensing report was provided.the state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Nicol Wesley and Sakinah Madyum conducted an unannounced Required 1 year inspection at the facility and met with Administrator Luzviminda Bulosan and explained the purpose for todays visit. The facility phone number is 562 466 9268. The facility consist of four resident bedrooms, two bathrooms, one of which is in bedroom number four, a living room, dining room, kitchen and patio located in the back yard, unattached garage(storage and overflow of food). During the visit the LPA utilized the CARE tool to complete the inspection. A Pre screening area with PPE supplies was observed upon entry into the facility. LPAs conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. The last fire drill was conducted May 18, 2025. LPA observed one fire extinguisher in the hallway. The water temperature was tested and measured 111.4 degrees F. Administrators certificate for Luzviminda A Bulosan #6025272740, expires on 09/25/2026. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Jun 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced Required- 1 year visit. LPA Rea met with Administrator Luzviminda Bulosan and explained the purpose of the visit. The facility has a Dementia waiver, and a hospice waiver for 2 residents. Facility is a single story home located in a residential area consisting of 4 bedrooms (2 shared & 2 private), living room/dining area, kitchen, outdoor covered patio area, shed, and laundry area located in the backyard porch area. There is a detached garage in the rear of the property presently being used as storage and staff "resting area". The last emergency disaster drill was conducted on 6/11/2024. Administrator certificate expires 9/25/2024. Facility was observed to be clean and in good repair. Temperature was between 68 degrees and 85 degrees Fahrenheit. All window screens were clean and in good repair. There was appropriate lighting in the facility and in each room. Protective devices were observed such as nonskid material on rugs. Indoor and outdoor passageways and stairways were free of obstructions. Stairways, inclines, ramps, open [porches and areas of potential hazard accessible to residents were well-lit and equipped with sturdy hand railings. The physical plant was consistent with the submitted facility sketch/floor plan. Disinfectants, cleaning solutions, poisons and other items which could pose a danger to residents were observed to be locked and inaccessible. Fire alarms, smoke alarms and carbon monoxide detectors were tested and operate properly. Resident bedrooms are large enough to allow for easy passage between and comfortable usage of beds and other required items of furniture, and any resident assistant devices such as wheelchairs or walkers if necessary. LPA observed a bed for each resident equipped with good springs, clean and comfortable mattress, pillow(s) and bedding. Bathroom floors were observed to be clean, sanitary and odorless. The hot water temperature measured between 113.1-117.5 degrees Fahrenheit. There was at least one toilet and sink for each six persons and one bathtub and shower for each ten persons. All bathtubs, showers and toilets had grab bars, and non-skid mats. All bathtubs, showers, toilets, and skinks operate properly. LPA observed there to be sufficient supply of hygiene items such as soap, and toilet paper. LPA also observed there to be sufficient supply of clean linen, including blankets, bedspreads, top sheets, bottom sheets, pillow cases, mattress pads, bath towels, hand towels, and was cloths, to permit changing weekly or more often as needed. Kitchen and dining room floors were observed to be clean, sanitary and odorless. Trash cans had tight fitting covers. The kitchen area was clean and free of litter. Cleaning supplies are kept in areas separate from food supplies. There is confidential storage area for personnel records, resident records and administrative files, which will be kept in a locked closed in the living room. There is a locked centralized storage are for resident medications, which are kept in the locked closet in the living room. The first aid kit, was observed by LPA to include sterile dressings, bandages, thermometer, scissors, tweezers and a current first aid manual. Emergency exit plans and telephone numbers; Facility Theft and Loss Program, Licensing Complaint Poster; Residential Personal Rights; Resident Council Rights were all observed to be posted. The facility has laundry supplies and equipment, which includes a washer and dryer. There is an operating telephone available for resident use. Emergency flashlights were observed. There are no bodies of water present. There were no deficiencies cited. Exit interview conducted, and a copy of the report was provided to Ms. Bulosan.the state’s words, verbatim · CDSS document, Jul 5, 2024

Allegation investigated: Staff are not properly trained

Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial complaint visit regarding the allegation listed above. LPA met with Luzviminda Bulosan, administrator of the facility. The investigation consisted of the following: LPA interviewed Residents #1, 3, and 6 (R1, R3, R6), interviewed Staff #2 - 4 (S2 - S4), and also obtained Staff #1's (S1's) complete training records and reviewed the training records for all staff that work at the facility along with their associations in Guardian. LPA attempted to interview S1, however they were not present in the facility. LPA attempted to interview Residents #2, 4, and 5 (R2, R4, R5), however they were not able to answer questions due to cognitive impairment. The investigation revealed the following: in regards to the allegation "Staff are not properly trained", it is alleged that S1 along with one of their siblings have been working at the facility after 6 PM, and that they are not been properly trained which have led to resident falls when transferring them. Unsubstantiated During interviews with the Residents, none of them corroborated that S1 is not a properly trained staff member, nor that S1's sibling works at the facility. Both R3 and R6 explained that S1 is very helpful and very nice to both of them, and that the sibling of S1 does come to the facility as well but they do not witness the sibling performing caregiving duties and only comes to have conversation with them. During interviews with the staff, none of them corroborated that S1 is not properly trained, nor that the sibling of S1 works at the facility. S3 and S4 explained that S1 is their child and is properly trained and associated in the Guardian system. S3 and S4 explained that the sibling is also their child and occasionally comes to visit the facility on Saturdays for dinner because the sibling enjoys speaking with the residents, however they are currently a student in college and do not perform any caregiving duties. During record reviews of S1's training and the other staff members, LPA observed that all staff completed the required initial 40 hours of training upon hire, including the necessary 6 hours dedicated to Dementia Care along with 4 hours dedicated to Hospice Care, Postural Supports, and Restricted Health Conditions. LPA also observed training conducted for this year, and S4 explained that the facility staff will meet the annual training requirements by the end of the year. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 7, 2023 · control 28-AS-20231102145937