Lakeside View Elderly Care

Type of visit: Office

Licensing Program Manager (LPM) Troy Agard and Licensing Program Analyst (LPA) Jose Tan met with Administrator Emil Siapno for an office visit. Mr. Siapno stated that the Licensee Representative Kriesha Hidalgo would like to take over this facility despite their Operating Agreement and trying to remove him as the operator of the facility and came here to get advise from CCL. Mr. Siapno presented their Operating agreement to LPA and LPM. Mr. Siapno complained that Ms. Hidalgo and her mother is trying to sell the business he was running since 2001 and take over all the residents. He stated that they are showing the facility to potential buyers. This matter will be referred to the Regional Manager and will provide the next steps to Mr. Siapno in the coming days. Copy of this report provided.the state’s words, verbatim · CDSS document, Aug 24, 2026

Allegation investigated: Resident sustained injuries due to staff neglect. Staff leave resident soiled for extended periods of time resulting in resident developing a UTI.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Emiliano Siapno and explained the reason for the visit. LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:03 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM to 1:30 PM. Regarding the allegation that Resident sustained injuries due to staff neglect, it was alleged that Resident #1 (R1) had bruising on own arms but not with any part of R1's body. LPA's record review revealed that R1 when R1 was hospitalized on 12/25/25 and did not have any obvious bruises prior to hospitalization. LPA's interview with R1's family member (FM) today at 1:00 PM, revealed that FM witnessed R1 being restrained by the hospital staff because R1 forcibly removed own catheter which caused the bruises on R1's wrist and arm. Further interview also revealed that FM knew that R1 did not have bruises on arm and wrist while at the facility prior to hospitalization. Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff leave resident soiled for extended periods of time resulting in resident developing a UTI. LPA's record review today between 10:15 to 11:15 AM revealed that there was no diagnosis of Urinary Tract Infection (UTI) on R1's hospitalization admission and discharge record. LPA's interview with FM also revealed that FM witnessed facility staff never left R1 soiled for long and saw staff changing and checking R1's diaper while at the facility all the time. LPA's interview with four (4) incontinent residents today between 11:15 to 1:30 PM revealed that four (4) out of four (4) residents interviewed stated that they are regularly checked and changed by staff 3x to 5x a day including nights and did not witness any resident being left soiled for any period of time. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 16, 2026 · control 31-AS-20260106154125

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan met with Administrator Emiliano Siapno for a One (1) Year Required visit for this facility. LPA informed the Administrator the purpose of the visit. There is only one entrance being utilized at the facility. The facility had submitted and approved Mitigation and Infection Plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with Mr. Siapno at 12:16 PM. The facility is a single storey building with six (6) private bedrooms and five (5) bathrooms currently occupying five (5) residents. The facility is fire cleared for six (6) non-ambulatory residents, all of which may be bedridden. Hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were filled and last bought on 01/12/26. The facility is equipped with sprinkler system. There is a carbon monoxide detector installed at the facility. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility. The backyard has a locked big tool shed being used as miscellaneous storage. The garage is attached to the home and was locked and inaccessible to residents during the visit. The garage is also used as a stock room for emergency foods and as a laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in garage. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 107.8°F to 111.7°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aids kits have complete tools and supplies. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 01/04/2026. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan Assistant Administrator Emiliano Siapno for a One (1) Year Required visit for this facility. LPA informed the Assistant Administrator the purpose of the visit. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted . Hand washing,indoors coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with Mr. Siapno at 1:06 PM. The facility is a single storey building with six (6) private bedrooms and five (5) bathrooms currently occupying five (5) residents. The facility is fire cleared for six (6) non-ambulatory residents, all of which may be bedridden. Hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were filled and last bought on 05/25/24. The facility is equipped with sprinkler system. There is a carbon monoxide detector installed at the facility. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility. The backyard has a locked big tool shed being used as miscellaneous storage. The garage is attached to the home and was locked and inaccessible to residents during the visit. The garage is also used as a stock room for emergency foods and as a laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in garage. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 112.5°F to 115.8°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aids kits have complete tools and supplies. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 09/30/2024. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Nov 13, 2024

Allegation investigated: .Staff did not obtain medical care for resident in a timely manner 2. Staff did not provide adequate supervision

Licensing Program Analyst (LPA) Tuesday Cabiness met with the facility Administrator Emiliano Siapno, to conduct an unannounced subsequent complaint visit, to deliver the findings regarding the allegations mentioned above. The following was determined. Allegation # 1: It was alleged that staff did not obtain medical care for resident in a timely manner. On 11/17/21 from 930am to 12pm, Licensing Program Analyst (LPA) Jose Gary Tan conducted the initial complaint visit; conducted interviews and a physical plant inspection, as well as requested and reviewed facility documents. On 12/7/21 from 1245pm to 2pm, LPA Tuesday Cabiness conducted a subsequent visit; interviewed staff and reviewed resident records. According to the information obtained, resident #1 (R1) was admitted into the facility on 11/03/21 for respite overnight stays for 24-hour care. Staff and resident # 2 (S2) reported (R1) had difficulty sleeping and did not sleep throughout the night. (R1) kept walking back and forth, in and out of (R1s) room, and at one time (R1) was going through (R2’s) personal belongings. (R1) was agitated, and staff reported, they were up with (R1) all night into the morning trying to redirect (R1) back to bed in (R1’s) room. Unsubstantiated On 11/04/21, around 3:30am during one of the redirections by staff, (R1) turned around quickly and said to staff, “don’t touch me”, and tripped, causing (R1) to fall, and hit (R1’s) head and left side arm. (R1) was treated with 1st aid by staff. Staff stated the incident was reported to the Administrator and (R1’s) hospice agency. Staff started breakfast around 6:30am and (R1) ate breakfast then around 7am (R1) started complaining about pain in (R1’s) shoulder. Staff reported that upon (R1) complaining about the pain, staff reported the concern to the Administrator and hospice. Staff stated that the hospice nurse arrived around 10am on 11/04/21, treated (R1’s) wound and asked that (R1’s) responsible person take (R1) to get checked at the emergency hospital. The Administrator reported, he missed staff’s call during the night, when it came in around 4am on 11/04/21. Upon hearing the message, around 7am the Administrator immediately called (R1’s) responsible party and hospice. Although the notification was not immediately to the spouse upon (R1) falling, the notification was made within a timely manner which was confirmed by hospice staff who provided medical attention to (R1) on the same morning of 11/04/21. Therefore, based on interviews and documents reviewed, the allegation is deemed Unsubstantiated at this time. Allegation # 2: It was alleged on staff did not provide adequate supervision. On 11/17/21 from 930am to 12pm, Licensing Program Analyst (LPA) Jose Gary Tan conducted the initial complaint visit; conducted interviews and a physical plant inspection, as well as requested and reviewed facility documents. On 12/7/21 from 1245pm to 2pm, LPA Tuesday Cabiness conducted a subsequent visit; interviewed staff and reviewed resident records. According to the information obtained, resident #1 (R1) was admitted into the facility on 11/03/21 for respite overnight stays for 24-hour care. According to interviews with staff and resident # 2 (R2), (R1) had difficulty sleeping throughout the night, and kept walking back and forth, in and out of (R1’s) room, and at one time (R1) was going through the roommate’s (R2) personal belongings. (R1) was agitated, and staff and (S2) reported, being up all night with staff re-directing (R1) back to bed. On 11/04/21, around 3:30am during one of the redirections (R1) fell and injured (R1s) head and arm. Staff witnessed the fall and assisted (R1) by applying first aid. Staff reported to LPAs Tan and T. Cabiness, that he stayed in the room with (R1) the entire evening, due to (R1) not being able to sleep throughout the night. Staff also reported to both LPAs, that staff did not get any sleep that evening. Based on interviews, there is insufficient evidence to prove the allegation, therefore it’s deemed Unsubstantiated at this time. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Apr 11, 2024 · control 31-AS-20211108140602

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with staff Ronald Paison for a One (1) Year Required visit for this facility. LPA arrived and was greeted by Ronald who called the administrator and informed the purpose of the visit. Assistant Administrator Emiliano Siapno designated Mr. Paison to sign the report. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. A tour of the physical plant was conducted with Mr. Paison at 9:36 AM. The facility is a single storey building with six (6) private bedrooms and five (5) bathrooms currently occupying five (5) residents. The facility is fire cleared for six (6) non-ambulatory residents, all of which may be bedridden. Hospice waiver for six (6) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and inter connected and observed to be operational. The fire extinguishers were filled and last bought on 03/14/23. The facility is equipped with sprinkler system. There is a carbon monoxide detector installed at the facility. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility. The backyard has a big tool shed. The garage is attached to the home and was locked and inaccessible to residents during the visit. The garage is also used as a stock room for emergency foods and as a laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in garage. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 111.5°F to 119.1°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aids kits have complete tools and supplies. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 01/10/2024. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jan 21, 2024