House of Judah

Allegation investigated: Staff physically assaulted resident. Staff does not provide adequate supervision resulting in resident wandering away from the facility.

On 11/21/2025 at 8:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with Apakuki Nawasa and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 3. A brief interview with conducted with Apakuki. Allegation: Staff physically assaulted resident. It was alleged that a facility staff physically assaulted a resident. This investigation consisted of interviews with facility staff, residents, and the reporting party. On 10/01/2025 LPA Hughes conducted a visit to the facility and interviewed 2 out of 2 facility staff who both denied allegations of harming or physically assaulting a resident in care. On 11/19/2025 LPA interviewed 1 resident who stated that they have no concern about staff harming them or other residents in care. On 9/25/2025 LPA spoke with the reporting party who stated that resident (R1) was observed for any signs of physical ailments, but nothing was observed. Continuation 9099-C Unsubstantiated LPA attempted to speak with resident (R1) but was unable as the resident declined to speak or be interviewed during the facility visit on 10/01/2025. Due to a lack of evidence, the allegation could not be corroborated at this time. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. During a subsequent interview, the reporting party disclosed that facility staff were unaware resident (R1) had left the facility. This allegation is not in compliance with Title 22 regulation 87468.2(a)(4) as the facility did not ensure residents in care were provided with adequate supervision. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Apakuki and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Nov 21, 2025 · control 27-AS-20250922183708

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 28, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All 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 was not met as evidenced by: The licensee did not ensure residents in care were provided with adequate supervision. On 9/19/2025 residents in care were left unassisted under the supervision of a housekeeper who was unaware the facility staff had left the facility, and unable to meet the residents care needs.the state’s words, verbatim · CDSS document, Nov 21, 2025

Plan of correction: Licensee agrees to remain in compliance with Title 22 regulation 87468.2. Licensee will ensure the facility has adequate staffing at all times. Licensee will conduct staff training related to resident care and supervision in the facility. Licensee will send proof of training to LPA Hughes via email by 11/28/2025.

Type of visit: Case Management - Other

On 11/5/2025 at 8:55AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility announced to conduct a case management inspection. LPA met with licensee Apakuki Nawasa and explained the purpose of the visit. The census is 0. The purpose of this visit is to finalize the facility's closure and confirm that no residents are still residing at the facility. The licensee has ceased operations at this property, and relocated to a new location. During today's visit, LPA conducted a tour of the facility and found no residents or personal belongings left in the home. The licensee formally surrendered their facility license to LPA Hughes on 11/5/2025. An exit interview was held with the Licensee/Administrator Apakuki Nawasa. Link to survey for Facility Closure provided to Licensee. A copy of this report was provided to the Licensee at the end of the visit. www.surveymonkey.com/r/facilityclosurethe state’s words, verbatim · CDSS document, Nov 5, 2025

Allegation investigated: Staff is refusing to accept resident back after hospital stay

On 03/24/25, Licensing Program Analysts (LPAs) Pang Lee and Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPAs met with care staff Bulou Matamadua. The purpose of this visit is to deliver complaint finding for the allegation above. The current census is 4. It was alleged that staff is refusing to accept a resident back after their hospital stay. The investigation included interviews with facility staff and a review of records. According to an interview with Staff 1 (S1), Resident 1 (R1) was sent to Kaiser on 02/05/25 due to behavior issues and not being at their baseline. S1 stated that when R1 was ready for discharge, the hospital contacted S1, but S1 informed them that R1 would only be accepted back into the facility if R1's medication was adjusted to address R1’s behavior. A review of the records confirmed that R1 was admitted to Kaiser for delirium, and it was learned that R1's medication had been adjusted. Continued LIC 9099-C Unsubstantiated The investigation also revealed that R1 was readmitted to the facility on 02/07/25, following R1’s discharge from the hospital. Based on interviews and record reviews during the investigation, LPA was unable to corroborate the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.the state’s words, verbatim · CDSS document, Mar 27, 2025 · control 27-AS-20250207170146

Type of visit: Required - 1 Year

On 03/27/2025 at 8:30am, Licensing Program Analyst (LPA) Pang Lee and Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Lee and Hughes met with caregiver Bolou Matamadua and explained the purpose of the visit. Bolou called the facility designated administrator to inform that CCLD was present in the facility. The current census is 4 with 3 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA's observed the facility to be free of odor, clean and in good repair. LPA's observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA's toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 116.2 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the the entry way and was last serviced on 06/08/2023. During today's visit the administrator purchased a new fire extinguisher. LPA's observed the facility has a has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 73 degrees Fahrenheit. LPA's observed toxins located in the hallway closet and kept locked and inaccessible to residents. LPA's observed sharp knives kept locked in the kitchen and inaccessible to residents. Continue LIC 9099-C LPA's checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 2 out of 4 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA's requested resident and staff files for review. LPA's reviewed 3 out of 3 resident files and they were complete. LPA's reviewed 3 staff files, and 1 out 3 was incomplete staff 1 (S1) was missing health screening and TB results in file. LPA's reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared However S1 was observed present and providing care but was not associated to the facility. Therefore administrator sent S1 home. The following documents will be email to LPA by 04/04/2025 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report (7) LIC 309 Administrator Organization As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Mar 27, 2025

Allegation investigated: Staff did not ensure resident is adequately fed resulting in resident losing weight Licensee does not ensure staff are properly trained Staff does not ensure reporting requirements are being followed Staff did not prevent resident from developing a pressure injury while in care

On 03/03/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with staff nand explained the purpose of the visit. The purpose of the visit was to deliver complaint findings for the allegations above. Current census was 6. A brief interview with FDR was conducted. Allegation: Staff did not ensure resident is adequately fed resulting in resident losing weight. It was alleged that staff did not ensure that resident is adequately fed resulting in resident losing weight. During the course of this investigation, LPA conducted interviews and reviewed facility records. Based on interviews conducted with 3 residents. 3 out 3 residents state that they have enough food eat however the type of food eaten could be changed throughout the week. An interview with 3 staff members were conducted. 3 out 3 staff members deny that they do not feed the residents with enough food. 3 out 3 residents state that there is plenty of food for residents to eat. A review of facility records were conducted. LPA reviewed 3 resident weight logs, based on records review 3 out 3 residents had remained the weight or have lost 2 pounds within the last 2-3 months. Based on information gathered, it is unclear if the staff did not ensure resident is adequately fed resulting in resident losing weight. Unsubstantiated Allegation: Licensee did not ensure that staff are properly trained. It was alleged that the facility staff are not receiving adequate training. During the course of this investigation LPA conducted staff interviews and reviewed facility files. Based on interviews conducted it was learned that this facility holds a new-hire orientation that includes but is not limited to, Personal care services, Physical limitations, psychosocial needs, resident's rights, and policies and procedures regarding medications. After the staff member completes training the staff member is assigned to a "buddy" to follow during the first few shifts to ensure that they are comfortable working with the residents. In addition, staff is provided annual training throughout the year. LPA reviewed staff records which confirm that orientation training and annual training have been conducted for staff. Based on the information gathered, it is unclear if the licensee did not ensure that staff are properly trained. Allegation: Staff does not ensure reporting requirements are being followed It was alleged that staff does not ensure reporting requirements are being followed. Based on interviews conducted it was learned that R1 had fallen during the time that another staff member was present. However, LPA was unable to corroborate information regarding this fall by the administrator, staff, and other residents at the facility during these falls. Based on this information, it is unclear that the facility did not ensure reporting requirements are being followed. Allegation: Staff did not prevent resident from developing a pressure injury while in care It was alleged that staff did not prevent resident from developing a pressure injury while in care. Based on interviews conducted, 3 out 3 staff members denied that R1 had a pressure injury while in care. 3 out 3 staff members state that they conduct skin checks with the residents about 3 times a day and have not seen any redness or discoloration on R1’s body. In addition, LPA conducted an interview with R1 who denies that they have any type of injury on their body during the LPA’s visit. Based on the information gathered, it is unclear if the staff did not prevent resident from developing a pressure injury while in care. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Mar 3, 2025 · control 27-AS-20241007105632

Type of visit: Case Management - Deficiencies

On 10/15/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a case management visit. LPA met with Staff Member (SM) Stella Durutumada and explained the purpose of the visit. LPA Pascua asked that staff call the Facility Administrator to inform them that CCL was present. At 3:37, LPA Pascua met with Dede Matamadua. This visit is in response to the complaint visit conducted on 10/15/2024. During this visit LPA toured the facility and observed the refrigerator door, and two pantry doors locked. LPA Pascua was informed the facility locked the refrigerator and pantry doors due to a resident wanting to obtain food at all hours of the day. LPA Pascua informed Facility Representative (FR), that the facility could not lock any food supply away from the residents. LPA Pascua asked that the facility take off all locks of the refrigerator and two pantry doors. LPA Pascua continued to tour the kitchen and observed that knives and toxins were made accessible to the residents. LPA observed 2 large knives in the dishwasher and was accessible to the residents. A medication box was found in the refrigerator and this LPA was able to access this medication box and found that medication was currently stored and was made accessible to the residents in care. A tour the residents bedrooms were conducted, it was observed that a resident did not have clothing on their bottom half and was exposed with their bedroom door opened. During interviews conducted, LPA Pascua was also informed that a staff member currently sleeps in the same bedroom as R1. Based on the observations made during today's visit, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. An exit interview was conducted, appeal, and a copy of the report was given end the of this visit.the state’s words, verbatim · CDSS document, Oct 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Oct 16, 2024

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This is not met as evidenced by: Based on observation and interview, The licensee did not ensure that knives and toxins were made inaccessible to the residents in care. LPA observed the lock under the sink unlocked and had accessiblity to the cleaning supplies and knives under the sink. In addition, LPA observed two large knives under in the dishwasher. This poses an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee shall provide a statement of acknowledgement and correction to the LPA by POC date. Kitchen cabinet that housed knives and toxins were locked during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR80076(a) · Plan of correction due date: Oct 16, 2024

( 4) Between meal nourishment or snacks shall be available for all clients unless limited by dietary restrictions prescribed by a physician. This is not met as evidenced by: Based on observation and interview, The licensee did not ensure that the refrigerator and two pantries were accessible to the residents in care. LPA observed 3 black locks on the refrigerator and two pantries. This poses an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee shall provide a statement of acknowledgement and correction to the LPA by POC date. Locks were taken off during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a) · Plan of correction due date: Oct 16, 2024

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: This is not met as evidenced by: Based on observation and interview, the licensee did not ensure that the residents and staff had comfortable living accommodations. LPA learned that the staff member is sharing an room with R1. This poses a immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee shall provide a statement of correction and acknowledgement to the LPA by the POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR80072(a)(2) · Plan of correction due date: Oct 16, 2024

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This is not met as evidenced by: Based on observation, Licensee did not ensure that R2 had clothing on their bottom half. LPA observed through touring the facility that R2 had their door open and was able to be seen with no clothing on their bottom half. This poses an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee shall provide a statement of correction and acknowledgement to the LPA by the POC date. Licensee shall conduct training on personal rights to no less than an hour of duration. A copy of this training must be provided to the LPA.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Oct 16, 2024

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This is not met as evidenced by: Based on observation The licensee did not ensure that medication was made inaccessible to the residents in care. LPA observed a medication box in the refrigerator and was made accessible to the residents in care.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee shall provide a statement of correction and acknowledgement to the LPA by the POC date. Locked medication box shall be relocated into a seperate area and made inaccessible to residents in care.

Type of visit: Prelicensing

On 3/22/24, Licensing Program Analyst (LPA) Tung Truong arrived announced to conduct a follow up Pre-licensure visit. LPA met with Applicant, Apakuki Nawasa, who assisted with today’s inspection. During today's visit, the hot water temperature was measured at 109.9*F which is within the required range of 105-120*F. All corrections were completed, and the applicant has passed the pre-licensing visit. Based on a review of this facility during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time. Applicant has completed Component III before and therefore, waive this requirement. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. Per the California Code of Regulations Title 22, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was given to the applicant.the state’s words, verbatim · CDSS document, Mar 22, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tung Truong arrived at the facility to conduct an announced pre-licensing visit on 3/14/24. LPA Truong met with Applicant, Apakuki Nawasa who assisted LPA in today’s inspection. The facility has a fire clearance for 6 non-ambulatory residents. LPA observed there are no residents at this time. Apakuki will be the designated Administrator for the facility, Administrator Certification #6028899740 Expiration date: 06/05/2024. LPA toured and inspected the physical plant inside and outside to ensure compliance with Title 22 regulations. LPA observed the facility is clean and furnished. LPA observed rooms to have required furniture. The temperature inside the facility was observed to be at 70*F which is within the required range of 68-85*F. Hot water temperature was measured at 95.4*F which is not within the required range of 105-120*F. LPA observed area where food supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days will be maintained on the premises. LPA observed knives and toxins to be locked away and inaccessible to residents. Smoke and carbon detectors were in good repair. LPA observed fire extinguishers and first aid kit were up to date. LPA observed the centrally stored medication area where medication will be kept locked and made inaccessible to the residents. LPA observed no obstruction of emergency exits inside or outside of facility. Pre-Licensing is incomplete with deficiencies to be resolved by 3/22/2024. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies. Exit interview held, and a copy of the report was given to the applicant.the state’s words, verbatim · CDSS document, Mar 14, 2024