Coral Assisted Living

Type of visit: Required - 1 Year

On 01/07/2026 at 12:00PM, Licensing Program Analysts (LPAs) Andrew Christy and David Doidge arrived unannounced to conduct the 1-Year Annual Required inspection. LPAs met with caregiver, Antoinette Russell, and explained the purpose of the visit. Administrator Samuel Tet arrived around . The facility currently houses five (5) residents with a max capacity of six (6) residents. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. No bodies of water were observed. A comfortable indoor temperature is maintained at 71.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 113.5 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 03/17/2025. At 1:15PM, LPAs reviewed five (5) resident files and four (4) staff files, all found to be complete. The emergency disaster plan was last reviewed 09/01/2025. Quarterly emergency drills were last conducted 09/01/2025. A review of resident medications and the Medication Administration Record (MAR) found no outstanding errors. No deficiencies cited during visit. Exit interview conducted and a copy of this report was provided to the administrator.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Case Management - Other

On 04/09/2025 at 10:45 AM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident that occured on 03/22/2025. Administrator self-reported the incident on 04/07/2025. LPAs met with Administrator, Samuel Tet, and explained the purpose of the visit. LPAs received a self-reported incident report from the facility that indicated that Resident 1 (R1) went AWOL and was found by the neighbor. The neighbor contacted the police, and R1 was escorted back to the facility by the police. The facility did call 911 when the incident occured. During the visit, LPAs reviewed R1's Physician's Report dated 10/04/2024 that indicated that R1 has a diagnosis of Mild Cognitive Impairment and is unable to leave the facility unassisted. Upon waiting for the Administrator to arrive, LPAs observed one staff caring for 6 residents at one time during the visit. LPAs observed Staff 1 (S1) go into the staff room leaving the residents unattended. Based on interview, Administrator stated that he doesn't think that the alarm was working at that time. Administrator confirmed with LPAs while reviewing the Ring Camera, there was no indication of the resident leaving the facility due to the alarm system not operating properly. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 9, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Apr 30, 2025

87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities ...(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on record review and interview, the licensee did not comply with the section cited above by not providing supervision causing R1 to leave the facility which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The licensee agrees to obtain a new Physician's Report, Appraisal Needs and Services Plan, update LIC500, change the alarm system, and send proof to CCLD by POC date.

Type of visit: Case Management - Other

On 04/09/2025 at 12:10 PM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen while conducting a Case Management Visit. LPAs met with Administrator, Samuel Tet. On 04/07/2025, CCLD received an incident report of Resident 1 (R1) who AWOL from the facility on 03/22/2025. Facility failed to report as required. LPAs confirmed with the Administrator that the incident occured on 03/22/2025. However, CCLD received the incident report on 04/07/2025. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 9, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 16, 2025

87211(a)(1)(D) Reporting Requirements: (D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidence by: Based on record review, the licensee did not comply with the section cited above by not reporting the incident in a timely manner which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2025

Plan of correction: The Administrator agrees to review the regulation, submit a self certification of the regulation, and send proof to CCLD by POC date.

Type of visit: Prelicensing

On 12/30/2024 at 12:40 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Pre-Licensing inspection. LPA met with Administrators, Alexandru "Alex" and EcaterinaTet and explained the purpose of the visit. The facility currently has six (6) residents. Licensee/Administrator, Samuel Tet, arrived shortly. LPA toured facility with Alex and Ecaterina including but not limited to six (6) bedrooms, three (3) bathrooms, kitchen, garage, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility. Room temperature was maintained at 73 degrees F and hot water temperature was measured at 114.0 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was purchased on 04/23/2024. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 30, 2024

The state marks this report as 6 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Change of Ownership Capacity: 6 Census (if any clients in care): 6 COMP II Participants: SAMUEL TET Interview Method: Telephone interview On December 12, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 12, 2024

Type of visit: Prelicensing

This report is being amended due to LPA T. Syess-Gibson generating a Pre-licensing Report under wrong facility number. LPA did generate a correct report under the correct facility number. LPA has been given authorization from LPM H. Humpal to amend the report. *****This is an Amended Report*****the state’s words, verbatim · CDSS document, Sep 12, 2024