Golden Haven Care Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by facility staff Dennis Chua. Facility is a Residential Care Facility for the Elderly. Administrator unable to attend visit. There are currently three residents in facility. LPA and staff 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. Door screen heading out to backyard not in good repair, LPA advised admin to replace door screen and ensure as required by regulation that all window and door screens must be in good repair (Technical Violation, given) All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 2/11/2026. Fire alarms and carbon monoxide detector were tested and operational. Outdoor emergency exit clear from obstruction. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Facility kitchen, refrigerators and freezers were clean, and food was stored properly with expiration dates noted. Toxins are stored in a locked closet/cabinet and inaccessible to residents. Sharps and knives were locked in kitchen drawer. Emergency water and food supply available. Facility had an ample supply of linens, towels and extra hygiene products for residents. 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. Water temperature accessible to residents measured within the allowable range of 105 to 120 degrees F. Disaster drills are being conducted. continued onto 809C.... continued from 809... LPA reviewed 3 of 3 resident records. Three out of three resident physician reports were not up to date. LIC602, Medical Assessment for all three residents were over 12 months old (Deficiency Cited, see 809-D). LPA reviewed 2 staff records. All required documentation was present. 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 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. Exit interview conducted and report read with Administrator.the state’s words, verbatim · CDSS document, Jun 10, 2026

Type of visit: Required - 1 Year

At approximately 10:00am Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection visit. LPA was greeted by facility administrator Rosalina Lubuguin. Facility is a Residential Care Facility for the Elderly that has a fire clearance approved for six non-ambulatory residents with a hospice waiver approved for 1 resident. LPA and admin 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 2/24/2025. Fire alarms and carbon monoxide detector were tested and operational. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. LPA observed various foods without expiration dates noted. LPA had conversation with admin to note expiration dates on all foods being stored in refrigerator. Sharps and knives were locked and inaccessible to residents. LPA observed toxins to not be secure, closet where chemicals were stored did not have secure lock. LPA observed chemicals out throughout facility including lysol wipes, Clorox and window cleaner accessible to residents (Deficiency cited, see 809-D). Outdoor emergency exit clear from obstruction. LPA observed no outdoor furniture accessible for residents. LPA had conversation with admin to ensure that outdoor furniture or chairs are residents to have outdoor activity. Facility had an ample supply of linens, towels and extra hygiene products for residents. 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. Water temperature accessible to residents measured within the allowable range of 105 to 120 degrees F. Disaster drills are conducted monthly with the last drill conducted on 7/02/2025. continued onto 809-C.... Continued on from 809... LPA reviewed 4 of 4 resident records. All required documentation was present. Physician reports were up to date. LPA reviewed 2 staff records. All required documentation was present. LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies. LPA observed medication transferred between other containers. LPA had conversation with licensee to ensure they continue to only pour for next medication pass. 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 (Retrieved during visit) LIC308- Designation of Responsibility (Retrieved during visit) Liability Insurance 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. Exit interview conducted and report read with Administrator.the state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Required - 1 Year

At approximately 10:00 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Prima Eudelyn Rabena. Administrator, Rosalina Lubuguin arrived shortly after at approximately 10:20 AM. The facility is a single story home licensed for six (6) non-ambulatory residents, two (2) can be bedridden, and a hospice waiver capacity of three (3). The facility currently provides care for five (5) residents. Four out of five residents were at home and one out of five residents was at a doctors appointment. In addition, there are two (2) residents with a diagnosis of dementia and one resident on hospice. At approximately 10:15 AM, LPA and administrator toured the building and grounds which was found to be clean and in good repair. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and kitchen. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 112.1 and 114.2 degrees F at three of three faucets accessible to residents. One out of one fire extinguisher was inspected and charged. Eight out of Eight Smoke detectors were present and Carbon Monoxide detector was present, inspected and found to be in working order. There was enough lighting in all common areas, resident rooms, and hallways. Continued on 809C Continued from 809 Medications located in designated cabinet were found to be secured. LPA conducted a spot check of medications and found administering and records to be inaccurate. Resident was observed interacting with staff in bedroom and living room. Two of five residents were found in their room. Two of five residents were watching television .LPA observed staff checking and caring for residents often. At approximately 11:00 AM, LPA reviewed Five of Five resident records which were all found to be well organized. At approximately 12:00 PM, LPA reviewed two out of two staff records which were all found to be well organized. Medication records contained physician's orders for each resident. Administrator Rosalina Lubuguin Administrator Certification is expired, will provide proof of recertification education and application has been submitted. Continued from 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 500 Personnel Summary LIC 9020 Register of Facility Client’s/Resident's Staff Training Files/Records Updated 602s Evidence of Liability Insurance Evidence of Administrator Certification submission No citations issued during today’s visit.the state’s words, verbatim · CDSS document, Jun 11, 2024