Lotus Garden Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Marcella Tarin and Manuel Monter conducted an unannounced annual inspection and met with Administrator (ADM) Lori Mohassel. LPAs stated the purpose of the visit. LPAs toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed refrigerator temperature at 40 F and Freezer at 0 F. LPAs observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 9/7/2025. LPAs reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 7/25/2025. LPAs toured 6 resident bedrooms. All 6 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPAs toured 5 resident bathrooms. All 5 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPAs measured water temperature with a range of 118 F to 119 F. Page 1 of 2 LPAs reviewed 3 resident records. LPAs reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 3 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator Lori Mohassel and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Type A deficiencies cited on 9/27/2024. LPA Rai met with Administrator (ADM) Lori Mohassel and stated the purpose of today's visit. LPA Rai observed 2 staff and 6 residents in the facility. During visit, LPA Rai observed all outdoor and indoor passageways kept free of obstruction and all 6 exit door had removed secondary locks. LPA Rai observed resident R1's half-bed rail and reviewed physician's order for half-bed rail for mobility in resident's file. R1 is now under Hospice services. During visit, LPA Rai provided letter of the Deficiency Citations cleared. No deficiencies were cited at this time as per California Code of Regulations, Title 22. This report was reviewed with Administrator (ADM) Lori Mohassel and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 27, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Simi Rai and Santino Fortes conducted an unannounced annual inspection, and met with Administrator (ADM) Lori Mohassel. LPAs observed 3 staff and 6 residents at the facility. ADM stated there were 0 residents under Hospice services. LPAs toured the facility inside and out including: kitchen, living room, family room and 1 staff room, 6 resident rooms and 2 restrooms. LPAs observed 6 out of 6 exit doors in the resident rooms had secondary locks on the doors and was not kept free of obstruction wherein the door was not able to open without staff opening the locks with key. LPAs observed locked stoppers on the sliding door railings which restricted the sliding doors from opening. Staff had access to the keys to unlock door stoppers and secondary locks and were able to unlock all the doors during the visit. Licensee and ADM understood to keep all doors free of obstruction. LPAs observed 1 out of 6 beds had attached full bed rail in R1's room. Licensee and administrator stated that R1 was not receiving hospice services. Licensee and ADM will work with R1's primary care physician to obtain written order to use 1/2 bed rail for mobility. Restrooms observed to have non-skid flooring. LPAs observed perishable food supply of at least two days and non-perishable food supply of at least seven days. Refrigerator temperature was observed at 32 degrees F and Freezer temperature was 0 Degrees F. The front yard and backyard of the facility was also inspected. LPA observed one exit fence leading out of the facility was held up with a plank of wood. ADM stated they will repair the fence is not able to close properly. No outside storage shed was observed. LPA observed Facility License and Resident Personal rights were posted. Continuation on LIC 809-C, page 1 of 2. Page 2 of 2. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. Room temperature was at 74.5 degree F, and hot water temperature was measured from resident bathroom at 119.1 degrees F. LPA inspected the facility first aid kit and it was observed to be complete. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested. Fire extinguishers were last serviced on 9/20/24. The facility conducted their last fire drill on 8/1/24. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 residents medications and centrally stored medication records. Deficiencies were cited during today's visit as per California Code of Regulations Title 22., see LIC809-D Exit interview was conducted with Lori Mohassel (ADM). This report was reviewed and a copy was provided to ADM for signature. Appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 27, 2024

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Sep 28, 2024

87307(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation and interview, 6 out of 6 exit doors located in the resident rooms had secondary locks which prohibited the door from opening which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Sep 28, 2024

87608(a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by Based on observation, interview, and record review, R1 had full bed rails attached to the bed and R1 was not receiving hospice services which poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Administrator (ADM) Lori Mohassel and Licensee (LIN) Zenebesh Ghebresellasie. LPA Rai stated the purposed of today's visit. LPA Rai observed 3 staff in the facility, 3 residents sitting in living room, 1 resident sitting in the dining room, and 2 residents in the resident's rooms. At this time there is one resident under Hospice services. During visit, LPA Rai toured the inside and outside of the facility with LIN and ADM. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed secured areas for cleaning supplies and laundry detergents in the garage area. LPA Rai observed oxygen tank in resident R3's room. ADM stated R3 does not use oxygen tank and the oxygen supplier company will pick up the supplies from the resident's room. The facility bathroom had available soap, paper towels, and trash cans with lids. The shower had grab bars and non-skid mats. The water temperature in the bathroom sinks ranged from 105.6F-106.5F. Facility smoke detectors and carbon monoxide detectors were in working condition. 6 out of 6 resident bedrooms had available bedding, drawers, and functioning lights. LPA Rai reviewed facility records for 3 residents. LPA observed 2 residents did not have a completed appraisal/needs and services plan since their admission date. ADM and LIN could not located a completed appraisal/needs and services plan. ADM and LIN stated they will follow up with the resident's responsible party to create an appraisal/needs and services plan. Continuation on LIC 809-C, Page 1 of 3. Page 2 of 3. Facility did not maintain a weight log for 6 out of the 6 residents. LPA Rai reminded ADM and LIN need to observe resident for changes and this includes weight loss and weight gain. ADM and LIN will initiate a weight log for the residents to observe changes such as unusual weight gains or losses. LIN stated the facility staff will initiate measurement of resident's arms or thigh's to monitor resident's weight loss and weight gain for residents that are not able to use the regular weight machine. LPA Rai reviewed resident medications and central stored medication records. LPA Rai, LIN and S1 counted the medications for R1-R3. During a random review/audit of resident's medication bottle and LIC 622 Centrally Stored Medication and Destruction Record, 2 out of 5 medications prescribed to R1 was not given as prescribed by the doctor. LPA Rai along with LIN and S1 counted the tablets from the medication bottles. R1's medication #1 were counted 64 tablets instead of 61 tablets, which concluded there were 3 extra tablets in the bottle and medication was not administered according to the MD's prescription and order on the prescription bottle. R1's medication #4 were counted 67 tablets instead of 64, which concluded there were 3 extra tablets in the bottle. 1 out of 5 medications prescribed to R2 was not given as prescribed by the doctor. LPA Rai along with LIN and S1 counted the tablets from the medication bottles. R2's medication #3 were counted 58 tablets instead of 52 tablets, which concluded there were 6 extra tablets in the bottle and medication was not administered according to the MD's prescription and order on the prescription bottle. 2 out of 2 medications prescribed to R3 was not given as prescribed by the doctor. LPA Rai along with LIN and S1 counted the tablets from the medication bottles. R3's medication #1 were counted 42 tablets instead of 32 tablets, which concluded there were 10 extra tablets in the bottle and medication was not administered according to the MD's prescription and order on the prescription bottle. R3's medication #2 were counted 10 tablets instead the medication bottle being empty and medication was not administered according to the MD's prescription and order on the prescription bottle. LPA Rai review facility records for 3 staff. LPA Rai observed 3 staff members did not have first aid training on file. ADM and LIN stated the facility staff have not been first aid training by a agency such as American Red Cross and 3 out of 3 staff will enrolled to first aid training. ADM and LIN will submit the completed first aid training and or certification to LPA Rai once completed. Page 3 of 3. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. 87411 Personnel Requirements - General is being cited during today's visit. LPA Rai would like to clarify the facility personnel being in sufficient in numbers is not the concern, however the facility personnel's actions and documentation are observed to be not competent to provide the services necessary to meet the resident's needs. Exit interview was conducted with Administrator Lori Mohassel and Licensee Zenebesh Ghebresellasie and they both agreed and understood the deficiencies and the Plan of Correction for each citation. A copy of this report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Oct 23, 2023