Kingdom Hearts Care Home

Type of visit: POC

Licensing Program Analyst Manuel Monter conducted a POC case management visit to clear deficiencies cited on July 31, 2026. LPA met with Staff Melani Ablan and explained the purpose of the visit. The facility was cited the following Type A deficiency on July 31, 2026 87309 Storage Space and Access (a), POC due date August 1, 2026 The facility was cited the following Type B deficiency on July 31, 2026 87465 Incidental Medical and Dental Care Services (h)(5), POC due date, August 7, 2026 LPA received plan of corrections for type A and type B deficiency by POC due date. Deficiencies cleared during todays visit. POC cleared letter provided to ADM No deficiency was cited during todays visit. This report was reviewed with Staff Melani Ablan. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Anabelle Ablan. During the visit, LPA observed 4 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with Staff S1 Normalee Bunnao which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. LPA toured bedroom #6. LPA observed a medication container accessible to residents in care on top of the dresser. Staff S1 secured the medication during the visit. LPA also toured bedroom 5, which is being used as a staff room. LPA noted the door was not locked, and a note written tape, in the inside of the door, which states "don't lock." Inside the staff room, LPA observed a 100 count, Centrum multivitamin container, accessible to residents in care. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 78 degrees F, and hot water temperature was measured at 114 degrees F in resident bathrooms. Fire extinguisher was serviced in July 2, 2026. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on June 2026. LPA observed the locked medication storage area. LPA noted that the facility is pre-pouring resident R1-R4's medications. (Photographs taken.) ADM stated they pre-pour so the dosages are completed a week in advanced. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. Deficiencies are cited during today's visit, see LIC809-D. This report was reviewed with Administrator Anabelle Ablan and a copy of the signed report was provided. Appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 31, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Anabelle Ablan. During the visit, LPA observed 4 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 74 degrees F, and hot water temperature was measured at 108 degrees F in resident bathrooms. Fire extinguisher was serviced in July 8, 2025. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on June 3, 2025. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 1 residents. No deficiencies cited during today's visit. This report was reviewed with Administrator Anabelle Ablan and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jul 15, 2025

Allegation investigated: Staff refused to take resident, who sustained a fracture, for immediate medical attention

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint investigation to deliver the findings on the above allegations. LPA met with Staff, Melanie Ablan On April 15, 2024, the Department received a complaint alleging Staff refused to take resident, who sustained a fracture, for immediate medical attention. It has been alleged, on April 9, 2024, facility staff stated that it is a waste of resources to call 911 and have the client transported to the ER because it is normal for the client to have swollen legs. Page 1 Out of 2. Unfounded On April 15, 2024, the Department received an incident report (IR) regarding R1. The incident report stated on April 9, 2024, R1 arrived in a wheelchair to the day program. While assisting R1 from his/her wheelchair, staff noticed R1’s legs were swollen and was experiencing pain. Program Coordinator (PC) called R1’s responsible party and informed him/her of the observations. PC let R1’s responsible party that 911 would be called for R1. When 911 arrived R1 was still having a hard time ambulating and when placed on gurney, PC noticed his/her left leg had a quarter size bruise and fresh blood dripping down his/her leg. Later in the day PC spoke with Kingdom Hearts Staff S1 regarding R1’s swollen legs. S1 told PC it was normal for R1’s legs to be swollen and that it was a waste of resources to send R1 to the emergency room. PC told S1 it was different that day and R1 was complaining about pain. On April 25, 2024, Licensing Program Analyst Manuel Monter interviewed staff S1. S1 stated he/she mentioned to the day program that he/she didn’t want R1 transferred unnecessarily to the hospital and use resources unnecessarily. S1 stated a few weeks ago, the day program had R1 sent to the hospital. S1 stated after he/she was sent there, the resident returned with no issue. S1 stated he/she told the day program it was their call because they can see the resident in front of them. On December 4, 2024, Licensing Program Analyst Manuel Monter interviewed Day Program ADM (DADM) and Day Program Staff (DS1 & DS2). DS1 and DS2 stated when R1 had arrived to the day program, they observed R1 with swollen legs and R1 had expressed pain on his/her legs. DS1 contacted 911 and also called R1’s responsible party to inform him/her R1 was being sent to the hospital. DADM and S1 stated the phone call with Kingdom Hearts Care home staff, S1, was in the afternoon, after R1 was already sent to the hospital. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED. Although it is a fact that S1 did in fact say, “ it was a waste of resources to call 911 and have the client transported to the ER because it is normal for the client to have swollen legs”, based on interviews conducted, Resident R1 was in the care of the day program when 911 was contacted, and the phone call with the Care Home staff S1 was conducted after R1 had already been hospitalized. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Dec 16, 2024 · control 26-AS-20240415164143

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter and Santino Fortes conducted an unannounced annual inspection visit, and met with Administrator Anabelle Ablan. During the visit, LPA observed 5 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 109 degrees F in both resident bathrooms. Fire extinguisher was serviced in May 23, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on June 1, 2024. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 1 residents. No deficiencies cited during today's visit. This report was reviewed with Administrator Anabelle Ablan and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Aug 16, 2024

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter conducted an unannounced case management to amend a Case Management-Incident, LIC809, LIC809-C and LIC809-D issued on July 23, 2024. LPA met with Administrator Anabelle Ablan explained the purpose of the visit. The report issued on July 23, 2024 is being amended to issue a civil penalty and deficiency that was inadvertently not issued during the case management visit. A Deficiencies is cited during todays visit, see Case Management dated July 23, 2024 LIC809-D. This Report was reviewed with Administrator Anabelle Ablan. A signed copy was provided.the state’s words, verbatim · CDSS document, Jul 30, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit in regards to an incident report the department received on July 23, 2024. LPA met with Administrator (ADM) Anabelle Ablan and explained the purpose of the visit. (This Report is being amended to issue a civil penalty and deficiency that was inadvertently not issued during the case management visit.) On July 23, 2024, the department received an incident report stating the resident R1 had eloped from the facility. The incident report stated the following; resident R1, who has a neurocognitive disorder, left the facility without staff noticing. R1 was found 3 houses away from the park sitting on one of the benches. The Incident Report states the incident took place on July 19, 2024, at approximately between 6am to 6:30am. The incident report also states the facility staff noted that R1 was not found in his/her bedroom and the sliding door in his/her room was open and the door alarm was turned off. On July 23, 2024, LPA Manuel Monter arrived at the facility and rang the door bell at 3:15pm. LPA observed thru the front door's decorative glass that staff S1 was moving a table that was placed in front of the door. LPA also heard the staff S1 moving the table from the front door. LPA asked S1, why the table was in front of the front door. S1 stated it was because R1 had recently left the facility and R1 is trying to leave the facility. (Photographs were taken) LPA went to observe resident R1's bedroom, (bedroom #5). LPA observed staff S1 removing a stick from the bottom portion of the sliding screen door for bedroom #5 (Resident R1's bedroom). S1 stated this was done because R1 was trying to leave the facility. LPA asked S1 to open the bedroom #5's sliding screen door. When S1 opened the door, the door alarm did not ring. LPA also observed one of the facility's living room couch inside bedroom #5. Staff S1, S2 and ADM stated the couch was placed directly in front of bedroom #5's sliding screen door, was to prevent R1 from eloping. Staff S2 stated it was the ADM's idea on how to prevent R1 from leaving the facility. (Photographs were taken). Page 1 Out of 2. LPA toured resident bedroom #4 with ADM. Resident bedroom #4's sliding door alarm was turned off. Staff S2 stated R1 has attempted to leave the facility by going thru bedroom #4. ADM stated R1 has attempted to enter resident bedroom #4. LPA toured resident bedroom #3 with ADM. Resident bedroom #3's sliding door alarm was turned off. LPA toured resident bedroom #2 with ADM. Resident bedroom #2's sliding door alarm was turned off. LPA asked ADM why the front door was blocked with the table. ADM stated they put it there because "she doesn't know what to do any more, and know its a violation." ADM stated R1 also tries to get out of the facility through the front door. LPA reviewed R1's physician's report, dated June 10, 2024, which states that R1 has a neurocognitive disorder. The physicians report also states R1 is confused/disoriented and has wandering behavior. R1 also cannot leave the facility unassisted. Based on a review of R1's preplacement appraisal (LIC603) and Resident Appraisal (LIC603A), dated May 18, 2024, R1 "needs special observation/night supervision(due to confusion, forgetfulness, wandering). Based on record Review, R1's Appraisal/Needs and Services Plan (LIC625), dated May 18, 2024 does not address resident R1's wandering behavior. LPA requested to review facility staff training records, regarding dementia. ADM stated she left the training records back at her home and they were not available at thee facility. An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Anabelle Ablan. Appeal rights were provided. Page 2 Out of 2 END OF REPORT.the state’s words, verbatim · CDSS document, Jul 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jul 24, 2024

87468.1 Personal Rights of Residents in All Facilities (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This Requirement was not met as evidenced by: Based on interviews and observation, Resident R1's bedroom sliding door was blocked with a couch and a stick. ADM, S1 and S2 stated this was done to prevent R1 from exiting his/her bedroom. This poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send LPA a plan of action on how she will ensure she is providing a safe and healthful accommodations for R1. ADM stated she will send the plan of correction by POC date, July 24, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87307(d)(6) · Plan of correction due date: Jul 24, 2024

87307 Personal Accommodations and Services (d)(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This Requirement was not met as evidenced by; Based on interviews and observation, Resident R1's bedroom had a couch obstructing the exit outside. ADM, S1 and S2 admitted they obstructed R1's sliding screen door and the front door of the facility due to R1's exit seeking behaviors.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send a plan of action on how she will ensure All outdoor and indoor passageways and stairways shall be kept free of obstruction. ADM stated she will send the plan of correction by POC date, July 24, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(j) · Plan of correction due date: Jul 24, 2024

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This Requirement was not met as evidenced by; Based on observation, Resident bedrooms 2-5's sliding doors alarms were turned off. Based on record review, resident R1 cannot leave the facility unassisted and he/she has exit seeking behavior. This poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send a plan of action on how she will ensure all exits have an auditory device, turned on, to protect the health and safety of residents with exit seeking behaviors ADM stated she will send the plan of action by POC date, July 24, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(k)(7) · Plan of correction due date: Jul 24, 2024

87705 Care of Persons with Dementia (k)(7) For each incident in which a resident wanders away from the facility unsupervised...The report shall be made by telephone no later than the next working day and in writing within seven calendar days. This Requirement was not met as evidenced by; Based on interview with ADM, the ADM admitted that she did not contact community care licensing to make a report the next working day. ADM stated she did not know she had to call in to make a report. This poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send the letter by POC date, July 24, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(2) · Plan of correction due date: Jul 24, 2024

87405 Administrator - Qualifications and Duties (d)(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This Requirement was not met as evidenced by; Based on records reviewed and interviews conducted, Administrator did not exhibit the knowledge of applicable laws, rules and regulations resulting in serious violations involving a resident who eloped from facility which poses an immediate health safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send a letter of understanding regrading the regulation. ADM stated she will send the letter by POC date, July 24, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87463(a) · Plan of correction due date: Jul 24, 2024

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary...shall document changes in the resident's physical, medical, mental, and social condition... This requirement was not met as evidenced by; Based on document review and investigation, R1's needs and services plan was not updated after R1 had eloped from the facility. The facility did not update the care plan for R1 to meet his/her needs. This poses an immediate risk to the health of the resident.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send a plan of action on how she will ensure residents needs and services plans are updated in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. ADM stated she will send LPA a copy of R1's updated Needs and Services plan. ADM stated she will send the written plan of action to LPA by POC date, July 24, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Aug 2, 2024

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs ... by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by; Based on interviews conducted, resident R1 had elopped from the facility on July 19, 2024 and staff did not provide R1 with Care and Supervision to met his/her needs. This poses an immideate threat to health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will conduct training for her staff regarding wandering residents and elopement. ADM stated she will send documentation of training to LPA by POC date, August 2, 2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(f) · Plan of correction due date: Aug 2, 2024

87412 (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying... This requirement was not met as evidenced by; Based on interview conducted, LPA requested to review staff dementia training records. ADM stated the records were at her home and unavailable for LPA to inspect. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 23, 2024

Plan of correction: ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send the letter by POC date, July 26, 2024. ADM stated she will send staff dementia training records for 2023 & 2024, to LPA by POC date.

Allegation investigated: Facility is not administering Residents medications per physicians orders

On April 16, 2024, the Department received a complaint alleging facility is not administering Residents medications per physicians’ orders. On April 25, 2024, Licensing Program Analyst Manuel Monter conducted an unannounced complaint investigation visit. On April 25, 2024, Licensing Program Analyst Manuel Monter randomly audited 3 residents’ medications. LPA audited residents medications by reviewing the medication container/bottle and cross referencing them with the Centrally Stored Medication Log. Page 1 Out of 2. Substantiated While reviewing resident R1's medications, LPA and ADM discovered a discrepancy. Medication #1 has a start date of March 12, 2024. The instructions are 3 tablets, 3x a day, which would result to 9 tablets a day total. The total pill count for this medication is 900. The Centrally Stored Medication Log and the ADM stated the facility has administered the medication for 44 days since March 12. (44 days x 9 pills=396 + the 3 pills that have been given this morning=399). ADM counted the remaining number of pills in the container, which totaled 556 pills. (556+399=955, A total of 55 excess pills.) ADM acknowledged that there have been instances where 1 pill was given instead of 3 and she has informed R1's responsible party. On June 7, 2024, LPA interviewed staff S1 and S2. S1 states he/she doesn't know why there was an excess of 55 pills. S2 stated he/she did miss giving out R1's medication #1 sometime for the month April, in the afternoon pill passes. LPA interviewed facility ADM. ADM stated R1 did not have any hospitalization's since R1 moved into the facility. ADM stated R1 has not had any overnight stays since he/she moved into the facility. Based on a review of R1's physicians report, dated September 18, 2023. R1 cannot manage his/her own medication. Based on a file review, there are no incident reports regarding R1 stating he/she had any hospitalization's or medication errors since R1's admission. Based on interviews and evidenced reviewed the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D. This report was reviewed with Administrator Anabelle Ablan and a copy of the report was provided. Appeal Rights was provided. LPA Monter interviewed residents R1-R5. Resident R1 stated he/she had a fall but did not give an answer to when or where he/she had a fall. R2 and R3 stated resident R1 has not had a fall. Resident R4 stated he/she did not want to be interviewed. Resident R5 did not respond to LPA’s questions and is nonverbal. On May 7, 2024, LPA interviewed Witness W1. W1 stated he/she visits the facility weekly to see R1. W1 stated he/she has not observed any signs of R1 sustaining a fall since R1 moved into the facility. On June 7, 2024, LPA interviewed ADM. ADM stated R1 does leans forward in general when he/she seated in the wheel chair. ADM stated R1 will also lean forward when eating at the kitchen table or using his/her Ipad. ADM stated staff is present in the facility and have not observed R1 fall. A review of R1's Admission Agreement shows, R1 moved into the facility on September 23, 2023. A review of R1's physician's report, dated September 18, 2023, states R1 is non-ambulatory, based on physical condition. The form states R1 will not ask for help and attempts walking. A review of R1's Pre-Placement Appraisal, dated September 23, 2023, states R1 uses a wheel chair, but cannot get in and out unassisted. Based on a File Review, there are no incident reports regarding R1 stating he/she had any hospitalization's or falls since admission. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Page 2 Out of 2.the state’s words, verbatim · CDSS document, Jun 7, 2024 · control 26-AS-20240416133846

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 8, 2024

87465 Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidence by: Based on record review and interviews conducted, R1’s medications had an excess of 55 pills. ADM acknowledged that there have been instances where 1 pill was given instead of 3 pills. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 7, 2024

Plan of correction: ADM stated she will be conducting a medication training for her staff. ADM stated she will document the staff who attend the training and send the documentation to LPA by POC date. ADM stated she will send the plan of correction by POC date June 8, 2024.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to open a complaint investigation. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Administrator Anabelle Ablan. While investigating the complaint, 26-AS-20240416133846, ADM stated resident R1 had a fall on March 26, 2024, R1 had sustained a fall, which required stitches. Based on a review of R1's after visit Summary, dated March 26, 2024, R1 was seen for wound care-closed with stitches. Based on facility file review, the facility did not send an incident report for this fall. A deficiency is being cited per California Code of Regulations, Title 22. See LIC809-D. Exit interview was conducted with Administrator Anabelle Ablan. Appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 25, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: May 2, 2024

87211 Reporting Requirements (a)(1)(D) Any incident which threatens the welfare, safety or health of any resident..., or unexplained absence of any resident. This requirement was not met as evidenced by; Based on interview and records reviewed, R1 had sustained a fall in March 26, 2024. ADM stated she did not send an incident report for this fall. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 25, 2024

Plan of correction: ADM stated she will send a written plan of action on how she will ensure any incident which threatens the welfare, safety or health of any resident is reported to CCL. ADM stated she will send the plan of action by POC date, May 2, 2024.