Ema Board and Carehome

Type of visit: Required - 1 Year

On 10/29/2025 at 12:00pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Merla Fernandez, Caregiver. LPA spoke with Administrator, Edwin Liwanag, via telephone and explained the purpose of the visit. The administrator holds a certificate #7006273740 expires 10/23/2026. The facility’s fire clearance was approved for eight (8) non-ambulatory and two (2) bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms and three (3) bathrooms. One (1) bedroom is occupied by staff. No bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 117.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Fire extinguisher was last serviced on 11/05/2024. First aid kit was observed to be complete. Fire drill was last conducted on 10/3/2023. Continued on LIC809. Continued from LIC809. LPA reviewed three (3) staff and observed three (3) of four (4) files were current and complete. All five (5) resident files were reviewed and complete. LPA requested the following documents to be submitted to CCLD by 11/5/2025. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPA observed the following deficiencies: At 12:15, LPA observed during record review R1, R2, R3, and R5, did not have an updated medical assessment and appraisal needs and services plan. At 12:56pm, LPA observed facility did not have a supply of 7-day perishables and 2-day non-perishables foods for residents. At 12:57pm, LPA observed a recliner, 2 wheelchairs, chest of drawers, and 2 bedrails on left hand side of house in back yard. At 1:05pm, LPA observed smoke detectors and carbon monoxide alarms were not operable. At 2:05pm, LPA observed during record review S2 and S3 do not having annual training. At 2:05pm, LPA observed during record reviews S2 and S3 is not first aid or CPR certified. Continued on LIC809C. Continued from LIC809C. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Case Management - Other

On 5/1/2025 at 12:45pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 4/17/2025. LPA met with Merla Fernandez. LPA spoke with Administrator Edwin Liwanag, via telephone and explained the purpose of the visit. On 4/17/2025, LPA received an SOC341 for R1 leaving the facility on 4/16/2025. S1 stated R1 had a friend call a Uber to transport her to CPMC in San Francisco. S1 spoke with R1 and R1's friend before she left. R1 left facility without consent from her doctor. S1 stated two (2) days after leaving he received call from R1's nurse and social worker inquiring if she could return. R1 advised yes, but haven't heard anything else. Staff was not able to stop R1 due to her personal rights. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2025

Allegation investigated: Staff does not ensure resident health care needs are being addressed

On 10/29/2024 at 1:05pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to conduct an initial 10-day visit and deliver complaint findings for the allegation above. LPA met with Administrator, Edwin Liwanag and explained the reason for the visit. LPA interviewed staff and resident. LPA requested the following documents to be submitted to CCLD by 10/30/2024: home health visit frequency, home health admission, copy of after summary visit dated 3/11/2024, copies of home health documentation from 9/11/2024 to present. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. Based on interview with W1 facility is not ensuring R1's health care needs are being addressed because R1's primary doctor is in Fremont. S1 stated during interview that R1 refuses to go into the doctor's office, but has had several phone appointments. R1 was last seen in person by a doctor on 3/11/2024. R1's primary physician ordered home health visitation which is being conducted. R1 stated in interview that he doesn't want to go to the doctor and he is fine. Based upon the information obtained and the interviews conducted during the investigation. The above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Oct 29, 2024 · control 15-AS-20241024135303

Type of visit: Required - 1 Year

On 10/29/2024 at 9:50am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Merla Fernandez, Caregiver, and explained the purpose of the visit. Administrator, Edwin Liwanag, arrived at 10:15am. The facility’s fire clearance was approved for eight (8) non-ambulatory and two (2) bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms and three (3) bathrooms. One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. No bodies of water observed. A comfortable temperature is maintained at 69 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 120.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/16/2022. Emergency Disaster Plan was last posted on 10/3/2023. First aid kit was observed to be complete. Fire drill was last conducted on 10/3/2023. Continued on LIC809. Continued from LIC809. LPA reviewed four (4) staff and observed three (3) of four (4) files were current and complete. All five (5) resident files were reviewed current and complete. LPA reviewed a sample of medications. LPA observed the following deficiencies: At 10:10am, LPA observed during record review R1 did not have a hospice care plan. At 10:30am, LPA observed during record review S4 personnel file was incomplete. At 10:55am, LPA observed fire extinguisher was last serviced on 9/16/2022. At 10:55am, LPA observed mice droppings in kitchen drawer and a large rat trap in garage. At 10:55am, LPA observed milk of magnesia, mucinex, and Tussin in the refrigerator unlocked. At 11:50am, LPA observed facility did not have working smoke detectors. At 11:55am, LPA observed during record review facility has not conducted a fire drill. LPA requested the following documents to be submitted to CCLD by 11/5/2024. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Continued on LIC809C. Continued from LIC809C. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 29, 2024

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Staff member financially abuses resident Staff falsified resident’s documents Staff don't answer facility phone

On 3/21/2024 at 12:40pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegations above. LPA met with Merla Fernandez, Caregiver and explained the reason for the visit. LPA spoke with Administrator, Edwin Liwanag, via telephone. LPA obtained approval for Caregiver to sign documents. During the course of the investigation LPA interview staff, Reporting Party (RP), Resident 1 (R1), obtained and reviewed records. Allegation: Staff member financially abuses resident. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. During interview with RP it was stated that R1's rent was increased without knowledge and S1 has access to R1's bank accounts. Based on record review of the physician's report dated November 10, 2022, R1 is able to manage his own cash resources. Interviews with S1 and R1 indicates that R1 handles his own money and pays his own rent. S1 stated that R1's rent has been the same since he was admitted and that he has no access to R1's accounts. LPA reviewed cancelled checks written by R1 for his rent. Based on the investigation the above allegations are unsubstantiated. Allegation: Staff falsified resident’s documents. During interview with RP it was stated that S1 falsified documents for R1. Based on interview with S1 he drove R1 to the bank, but R1 went in and took care of his business. S1 also stated he helped R1 find a tax preparer because R1 asked for help. S1 did not sign any documents at the bank or tax preparer. R1 stated he has all his documents. LPA observed bank statements kept by R1. Allegation: Staff don't answer facility phone During interview with RP it was stated that the facility staff would not allow her to speak with R1. During investigation LPA observed while at the facility staff answering telephone. Staff stated they do answer the facility line, but if a resident does not want to talk they respect their personal rights. Based upon the interviews and information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Mar 21, 2024 · control 15-AS-20231219162259

Type of visit: Case Management - Other

On 12/29/2023 at 4:20pm, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson arrived to conduct an case management visit. LPAs met with Edwin Liwanag, Administrator and explained the reason for the visit. While LPAs L. Hall were conducting a complaint investigation (15-AS-20231219162259) on 12/29/2023. During record review LPAs observed that S1 had not reported to CCLD that R2 had been hospitalized and admitted into hospice services. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Dec 29, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a) · Plan of correction due date: Jan 8, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited aboved in reporting an incident to CCLD which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 29, 2023

Plan of correction: Administrator agreed to sumbit and LIC624 (incident report to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(d)(2) · Plan of correction due date: Jan 8, 2024

87632 (d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver... (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in notifying CCLD by subimtting a hospice notification which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 29, 2023

Plan of correction: Administrator agreed to review regulation 87632 and submit self-certification that the regulation has been reviewed and will be abided by going forward to CCLD by POC date.

Type of visit: Required - 1 Year

On 10/26/2023 at 1:30PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Merla Fernandez, Caregiver, and explained the purpose of the visit. LPA spoke with Administrator Edwin Liwanag via telephone. The Administrator currently holds a certificate (#6020847740) that expires on 10/23/2024. The facility’s fire clearance was approved for eight (8) non-ambulatory and two (2) bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) total bedrooms which and three (3) bathrooms. One (1) bedrooms is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. No bodies of water observed. A comfortable temperature is maintained at 67 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 102.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/16/2022. Emergency Disaster Plan was last posted on 02/18/2021. First aid kit was observed to be complete. Fire drill was last conducted on 03/16/2022. Continued on LIC809. Continued from LIC809. Four (4) staff records were reviewed and none have first aid certification. All six (6) resident records were reviewed and four (4) of six (6) did not have a current appraisal needs and services plan. LPA observed the following deficiencies: At 1:40PM, LPA observed knives and 2 pair of scissors sitting in container on kitchen counter. At 1:50PM, LPA observed there was not a 7-day of non-perishables and 2-day perishable foods available for the residents. At 1:55PM, LPA observed resident sitting in garage where Tide detergent, Clorox, and Lysol disinfect was accessible. At 2:10PM, LPA observed bathroom between bedrooms #6 and #4 door was being blocked in bedroom #6 by resident's bed, and staff using bedroom #4 to get to bathroom for staff use only. At 2:15PM, LPA observed oxygen tanks not on stands in R6's room. At 2:25PM, LA observed during record review that R1 and R6 was recently hospitalized and Administrator did not submit an incident report. At 2:35PM, LPA observed during record review that four (4) of six (6) residents did not have a current appraisal needs and services plan. At 2:40PM, LPA observed during record review that R1 and R6 did not have a home health agreement available for review. At 3:45PM, LPA observed during record review that S3 did not have a file available to review. At 3:50PM, LPA observed during record review that none of the staff have a first aid certification. Continued on LIC809C. Continued from LIC809C. LPA requested the following documents to be submitted to CCLD by 11/2/2023. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Resident roster The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 26, 2023