Happy Nest II

Allegation investigated: Staff do not communicate with resident's Primary Care Physican.

Licensing Program Analysts (LPA) Tena Herrera conducted an unannounced subsequent visit investigate the above-mentioned allegation. LPA met with Administrator Claire Itchon and the purpose for the visit was explained. The investigation consisted of the following: On 5/21/24 LPA’s Sara Martinez and Valerie Flores conducted the initial 10-day visit. LPAs toured the facility, conducted interviews with staff and collected pertinent documents related to Resident #1 (R1). On 5/22/26 LPA Herrera conducted phone interviews with 2 Staff (S1 & S2). During todays visit LPA Herrera toured facility, interviewed 1 Staff (S3), obtained the following documents within R1’s file: Admission Record (dated 3/14/24), Physical History and Exam (dated 2/15/24), Occupational Therapy Notes (dated 3/13/24), Post Acute Progress Notes (dated 3/12/24), SIRs dated 5/1/24 and 5/10/24; reviewed licensee phone text messages with Physican and R1's Daughter, and delivered findings on the reported allegation. (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff do not communicate with resident's Primary Care Physician. It is alleged that staff at the facility are not aware of R1’s medical conditions and/or history and have a lack of communication with C1 and their physicians. LPA interviewed 2 staff and both denied the allegation, S1 stated that they are involved with their residents at the facilities and keep good communication and record keeping with family and physicians. It was explained by S1 that R1 had an assigned nurse practitioner that would check on R1 and together they would assess the resident, R1 had been sent to the hospital twice, 5/1/24 R1 was hospitalized due to blood in catheter and 5/10/24 R1 was hospitalized per R1’s daughter and physicians request, R1 did not return to facility after hospitalization. Per S1, R1 was within baseline, urine was clear, R1 did not have pain and was responsive on 5/10/24, staff did not understand why daughter and physician were removing resident from facility, but the decision was respected. S1 stated they have tried to contact R1’s daughter after the hospitalization but there have been no returned calls, and provided proof of text message tread from 3/20/24 to 5/10/24 that had communication regarding R1's status, and need for medication refills. LPA obtained SIRs dated 5/1/24 and 5/10/24 that documented the information S1 provided regarding hospitalization's. LPA toured the facility; there are currently no residents at the facility. S1 stated that there haven’t been any residents at the facility since September 2026 and the facility is temporarily closed due to no census. Based on statements, interviews conducted, and review of resident files, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 24, 2026 · control 18-AS-20240513121324

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Myrna Lomboy, Caregiver/House Manager, and informed them of the purpose of the visit. At the time of the visit, there were one (1) staff member and zero (0) residents present. Lomboy stated that the facility has not had any clients since September 2025. Claire Itchon, Administrator, joined later during the inspection. Facility Overview: The facility is a one-story home with three (3) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational. Health-Related Services/Incidental Medical Services: The facility has medication storage cabinet with lock in the kitchen. Continued on LIC809-C.... Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. Upon entry, LPA was greeted by Myrna Lomboy, Caregiver, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and four (4) residents present. Facility Overview: The facility is a one-story home with three (3) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 109°F. Fire extinguisher located at kitchen has current inspection tag. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 12-3-2024 and 3-11-2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, May 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that five (5) clients live at this facility. There was two (2) staff members present. The Licensee, Claire Itchon conducted and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Five (5) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. George S Camua Administrator’s certificate expiration date is 11/08/2024. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 107.0 degrees F. Laundry is done in the garage. The laundry soap, cleaning supplies and chemicals are located in the garage which is locked. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There is no pool at the facility. There is two (2) secured gates that have a self-latching lock located on the northwest and northeast side of the house. LPA observed emergency supplies and two (2) first aid kits. The last emergency fire drill was conducted on 02/19/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed five (5) smoke detectors and one (1) carbon monoxide detector throughout the facility. There was one (1) fire extinguishers on site, date serviced was 02/29/2024. Pursuant to the Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Licensee, Claire Itchon.the state’s words, verbatim · CDSS document, May 7, 2024