Harmony Haven Care Home

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection following receipt of an incident report to the Department. LPA met with Michel Nguyen, caregiver, and stated the reason for today's inspection. LPA observed (3) residents in the common area and (3) residents resting in their rooms. LPA was advised of a new administrator at the start of the inspection spoke to the Administrator, Manav Soha, by phone, who indicated he started his position on June 1, 2026. The administrator confirmed he has a current RCFE Administrator certificate and there is a pending application for a new license that was submitted on/around the first part of June, 2026. LPA discussed how a 60-day written notice must be issued to the responsible persons/residents prior to the change in ownership. LPA stated that the change in administrator should have been reported within (30) days. LPA obtained an updated phone contact phone and email address for the new Administrator. Also discussed was the recent hospitalization of resident (R1) on July 15, 2026. The incident report notes that (R1) was sent out to the emergency room due to appearing shaky and not fully responding to staff. LPA confirmed this information with the Administrator and the caregiver that (R1) that (R1) returned to the community later the same day and has completed their (5-day) antibiotic course of Amoxicillin 500 mg, 3 times daily . LPA observed (R1) to be resting in their room during the inspection. The Administrator stated that (R1) returned to the community, under hospice, per the family's request. LPA and caregiver toured the interior of the facility and observed all residents to be resting and the facility was clean, in good repair and odor free. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is issued for not reporting the administrator change within (30) days. Exit interview with caregiver, who was authorized to sign today's report. Copy of report/appeal rights given.the state’s words, verbatim · CDSS document, Jul 29, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(g)(1-3) · Plan of correction due date: Aug 12, 2026

87211 Reporting Requirements (g) The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. The notification shall include the following: (1) Name and residence and mailing addresses of the new administrator. (2) Date he/she assumed his/her position. (3) Description of his/her background and qualifications, including documentation of required education and administrator certification. This requirement is not met as evidenced by: Based on interview with the new Administrator, the Licensee did not notify the Department, within (30) days, of the change in Administrator on June 1, 2026, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 29, 2026

Plan of correction: Licensee/Administrator agree to submit the specific documentation, per Regulation 87211, to the Department by August 12, 2026. Documents can be emailed to LPA or faxed to the Regional Office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and initially met with Kanika Townsy, caregiver, who contacted the Administrator by phone. LPA observed (2) residents watching television in the common area while lunch was being prepared (3) residents were resting in their rooms. Administrator, Cristina Ivascu, arrived around 1:15 pm. The facility is approved for (5) non-ambulatory residents, (1) bedridden, and has an approved hospice waiver for (6) residents. Currently there are (2) residents under hospice care. LPA toured the interior/exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout and both bathrooms have the necessary grab bars, skid-resistant flooring, and hygiene products. There is sufficient 2+day perishable, including fresh produce, and 7+ day non-perishable food. There is a small refrigerator for refrigerated medications in the kitchen. Sharps, toxins and mediations are locked in the kitchen. There is (1) unlocked exit and no pools. All exits are free from any blockages. Staff are aware of where utility shut off valves are. LPA reviewed (2) resident files and (3) staff files. Files are organized and contain the required paperwork. LPA reviewed medication and orders for (1) resident- there were no discrepancies noted. Staff is completing training as required, including for First Aid/CPR certifications. Administrator has current RCFE certificate ## 7011737740 (exp 6/5/2026). All staff are cleared/associated. Annual fee are by 3/5/2026. Insurance is current. There are no deficiencies cited in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a post-licensing inspection and initially met with Dajah Thomas, caregiver, who contacted the Administrator by phone. LPA stated the reason for today's inspection. Myles Baxter, Member arrived to assist LPA with the inspection around 1:30 pm. LPA observed (1) resident begin to eat lunch at the start of the inspection and a second resident in her room. The facility is approved for (6) non-ambulatory residents and has an approved hospice waiver for (6) residents. The Administrator arrived at 1:45 pm. Staff shift change took place at 2:00 pm and staff, Jillian Kulinski arrived. LPA toured the interior/exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout and both bathrooms have the necessary grab bars, non-skid flooring, paper products and soap. There is sufficient 2+day perishable and 7+ day non-perishable food on site. There is a small refrigerator for refrigerated medications in the kitchen and both refrigerator temperatures are monitored regularly. Sharps are locked in the kitchen. LPA reviewed 2 resident files and 2 staff files. Files were organized and contain the required paperwork. Staff is cleared/associated and has completed the required initial training. Training certificates observed on file. Staff have First Aid/CPR certifications also. Medications are centrally stored and secured near the kitchen. LPA reviewed the Dementia Plan of Operations that includes the updated regulations. Discussed updated changes to be made to the Admission Agreement effective Jan 2025. LPA obtained a current copy of liability insurance. There are no deficiencies cited in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, May 23, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived announced for a scheduled pre-licensing inspection and met with Administrator, Stephanie Baxter and Myles Baxter, member. There is a pending RCFE license for (6) residents, all of whom may be non-ambulatory. There are currently no residents present as this location is not currently licensed. LPA and Administrator toured the interior and exterior of the facility including the common areas, (2) private resident bedrooms, (2) shared resident bedrooms, (2) resident bathrooms, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting throughout. The bathrooms have the necessary grab bars, non-skid flooring, soap, paper towels, and a 20- second hand-washing poster. LPA observed 7+ day non-perishable food, and sufficient dishes, flatware and cooking pans in the kitchen. Sharps will be locked in the kitchen. There is a medication cabinet with a lock in the kitchen. All toxins will be locked in the laundry room. Hot water measured 110*F in the kitchen and the inside temperature measured 72*F. Fire extinguishers were last serviced on 1/9/25, and the smoke/monoxide alarms are in working order. There is a complete First Aid kit, paper supplies, and sufficient linens/towels/blankets. There are flashlights and night lights on hand. All resident rooms have the required furniture. There are various required postings visible in the common area, including the Theft & Loss Policy. There is one unlocked exit gate in the backyard, and a table/chairs on the patio. All exit doors have auditory alerts, and there are ramps at the front/back exits. There are activities and reading materials in the common area. LPA reviewed a sample resident file and staff file. Both files contained the required forms. Administrator to add a visitor sign-in area with visiting hours. Component III was reviewed during today’s inspection. Pre-Licensing is complete and this facility has no deficiencies. LPA to notify the analyst in Centralized Applications Bureau. Exit interview. Copy of report left at facility.the state’s words, verbatim · CDSS document, Feb 18, 2025