Kizuna Homecare

Type of visit: Prelicensing

On 10/31/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a scheduled Pre-Licensing to the facility listed above. LPA met with Administrator, Ana Tojo, and the purpose of today’s visit was explained. LPA was granted entry into the facility. An application was received by CCLD on 07/10/2025, for a Change of Ownership. The facility is a Residential Care Facility for the Elderly that serves residents aged 60 and over. The facility has an approved fire clearance for six (6) non-ambulatory residents, two of which may be bedridden in bedrooms 1 and 3, and an approved Hospice Waiver for 3. Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. It consists of four (4) resident bedrooms, two (2) bathrooms, kitchen, dining area, living area, attached garage, and outside activity area. The outside activity area has a table, with chairs and umbrellas. All walkways around the facility were observed clean, clear, and free of debris, obstruction, and hazards. LPA observed a pool in the back yard that has a fence around it and is inaccessible to residents. All windows, screens, and blinds were observed to be in good repair. LPA observed a screened fireplace that is inaccessible to residents. Bedrooms LPA inspected all residents’ bedrooms. LPA observed the residents’ rooms were clean and in good repair. LPA observed the rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for resident’s personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheet, blankets, comforter, and pillows. Bedrooms were observed with ample lighting. LPA observed an ample supply of linens in a closet in the hallway. Bathroom LPA inspected all bathrooms and observed them to be operable and within Title 22 regulations. LPA observed all showers were clean and free of mildew and mold. All safety handrails are securely fastened. LPA observed nonskid mats and shower chairs available in the showers. LPA observed an ample supply of toiletries, towels, and wash clothes for residents. The water temperature in the bathrooms measured 115.8-degrees and 116.5-degrees Fahrenheit. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. All appliances were observed operational and in good repair. LPA observed an ample supply of cookware, dishware, and cutlery. LPA observed a 2-day supply of perishable foods, and 7-day supply of nonperishable foods properly labeled and stored. The water temperature measured 108.4-degrees Fahrenheit. LPA observed knives and sharps secured in a locked drawer. All cleaning supplies were observed secured in the locked cabinet under the sink. Common Areas During the facility inspection, LPA observed in the living area there is a couch and three recliners to accommodate residents. LPA observed an ample supply of games, activities, crafts and reading material available. The dining room has a large table with chairs to accommodate residents. LPA observed the facility to be appropriately furnished at the time of visit. All rooms were observed clean and in good repair. LPA observed all rooms and hallways have ample lighting. The hallways have night lights. All walkways and hallways in the facility were observed clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature. Files LPA observed resident files and staff files secured in a locked file cabinet in the staff work area and are inaccessible to residents. LPA observed the Administrator has a valid Administrator Certificate, number 7016645740, active till 07/20/2026. LPA received and reviewed a copy of the facility’s Emergency and Disaster Plan For Residential Care Facilities for the Elderly (LIC610E). LPA observed a copy of the LIC610E posted in the facility in a hallway. LPA received and reviewed a copy of the facility’s Infection Control Plan. LPA observed a copy of the facility’s Infection Control Plan posted in the hallway. LPA observed all required signs and information posted inside the facility. LPA received and reviewed the liability insurance through Acord that is valid till 12/02/2025. Medications LPA observed Centrally Stored Medication secured in a locked cabinet in the staff work area and are inaccessible to residents. LPA observed and tested the lock on the medication cabinet. Medications are documented on a Medication Administration Record (MAR). Safety LPA observed two (2) fully charged fire extinguishers purchased in December 2024. LPA observed and tested all smoke detectors and carbon monoxide detectors and found them to be operable. All doors, exiting the facility, have an alarm that chimes when it is opened. The facility has a working landline telephone. LPA observed a First Aid kit with the required items and a current manual secured in the medication cabinet. LPA observed a supply of emergency food and water. LPA observed a supply of emergency lighting and batteries. There are no firearms or ammunition on the premises. Infection Control Upon entry, LPA observed a sanitizing station that consisted of a Visitor Sing in log, hand sanitizer, thermometer, and masks available. LPA observed required Infection Control signs posted in the facility. LPA observed an ample supply of cleaning products secured in locked cabinets. Administrator and LPA reviewed and discussed Component III. LPA did not observe any advisory deficiencies or violations. An exit interview was conducted with Administrator, Ana Tojo, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 31, 2025