Loving Arms Residential Care for Senior III

Allegation investigated: Staff are not accepting resident back to facility

Licensning program Analyst( LPA) Elena Mallett conducted an unannounced l Complaint investigation to investigate the above allegation. LPA was met by staff in charge Alfredian Sanedrin and the purpose of the visit was explained. Administrator Cynthia Pabalan was contacted by telephone and joined the visit shortly after. The investigation consisted of the following: LPA toured the physcial plant, interviewed four staff , including Administrator and reviewed three resident files. LPA obtained a current staff and resident roster and Resident 1's(R1) Admissions Agreement, Emergency Identification Sheet, Physician's Report, government ID, Preplacement Apprasial Infomration, Appraisals needs and Service Plan and Hospice Notes, Hospice visit schedule, Hospice face sheet and List of Hospice team.There were no immediate health and safety concerns observed during the tour of the physical plant. Regarding the allegation:Staff are not accepting a resident back to facility. It is alleged that R1 was not accepted back at the facility following the completion of a hospital stay. R1 was admitted to the hospital Substantiated and was not permitted to return to facility upon discharge. Four (4) out of four (4) staff confirm R1 did not return to the facility after hospital stay. One(1) out of (2) residents confirmed R1 did not return to the facility after hospital stay. Three (3) out of three (3) witnesses confirm R1 did not return to the facility after R1's hospital stay. Administrator states that R1 was not accepted back at the facility due to requiring a higher level of care than the facility could provide. Interviews with family members corroborate that the reason the Administrator gave for not accepting R1 back at the facility following R1's hospital stay was that R1 required a higher level of care than the facility could provide. LPA reviewed R1's file and the care required by R1 was noted. LPA asked Administrator to provide documentation that showed upon leaving the hospital R1 required a higher level of care than what had been required when R1 was initially retained at the facility but Administrator did not provide any further documentation. The investigation revealed that staff are not accepting resident back at the facility. Based on LPA’s record review and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiency cited on the attached LIC 9099D per Title 22 regulations. An exit interview was conducted with Administrator Cynthia Pabalan and a copy of this Licensing report was provided along with the Appeals Rights.the state’s words, verbatim · CDSS document, May 29, 2026 · control 28-AS-20260521111250

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: May 30, 2026

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition... Residents in All Facilities, (a) residents... have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions. ... The above requirement was not met as evidenced by R1 was not permitted to return to the facility after a hospital stay. Documentation did not support that the facility could no longer provide sufficient level of care.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: By POC due date Administrator will provide LPA with a signed statement of understanding of cited regulation sent to the Office fax.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elena Mallett conducted the required annual inspection. LPA arrived unannounced and met with Administrator Cynthia Pabalan. The purpose for today’s visit was explained. The facility is licensed to serve 6 elderly residents ages 60 and above, with bedrooms 1,2,3 approved for non-ambulatory and bedroom 4 approved for bedridden. There is a hospice waiver for 6 residents. There are currently no bedridden residents. One resident is on hospice. The facility is a single-story home located in a residential area in Norwalk, Ca. A tour of the facility includes: living room, kitchen, dining area, 4 bedrooms (2 double and 2 single), 2 bathrooms (1 bathroom located in client room), front yard, back yard, attached garage with laundry. Physical Plant & Environment Safety: LPA toured facility. The facility is well maintained and walkways and hallways are free of debris and obstruction. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The required furnishings, light and bed linens were observed. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested the one bathroom used by the residents and a deficiency was observed. See 809-D. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept locked and are inaccessible to residents. Smoke detectors and carbon monoxide detector are present but three smoke detectors were observed to not be functioning properly. A deficiency was cited. See 809-D There is fire extinguisher that was observed to be fully charged. Continued on 809-C Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Appliances were observed to be operable and able to properly store and prepare food. Due to time constraints only two of the CARE tool domains was completed. LPA will return at a later date to complete the rest. Deficiencies were cited today per Title 22 regulations. An exit interview was conducted with Administrator Cynthia Pablan and a copy of this Licensing Report along with Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced case management visit at the facility. The Administrator sent an incident report to let CCLD know that they have a busted pipe in the facility. At the time, the pipes burst and affected one master bedroom. When the inspector came to the facility to inspect and fix the pipe, they noticed that the floors in another bedroom was absorbed by water, so they have to evacuate the entire home. Two clients were placed at the Loving Arms Residential Care for Seniors II that is located next door. The Administrator sent CCLD and incident report for the busted pipes, but we are asking for an updated incident report and updated/detailed evacuation plan that describes how they will distribute medication, their plan to take the first aid kit and manual, how they will feed the residents, the staff that will stay at the hotel with the residents, how they plan on transporting the residents, notifying the next of kin to explain to them what has taken place and their plan to keep the residents safe, something more detailed than what we previously received. CCLD is asking for an updated/detailed evacuation plan. The facility is licensed to serve age range 60 and over. There are currently two individuals on hospice and one individual on home health. The Administrator will notify Continued on LIC 809C. the agencies of their evacuation to the hotel. The hotel the residents will reside at from May 6-13th, 2025 is Days Inn 17510 Pioneer Blvd, Artesia, CA 90701., 562 924 6700. If there will be an extention after May 13th 2025, the Administrator is planning on renting an Air BNB. A copy of this reports was given to the Administrator Lourdes Bisnar during the Exit interviewed.the state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Required 1 Year visit at the facility and met with Administrator Lourdes Bisnar. The facility is licensed to serve age range 60 and over. Bedrooms 1,2,3 approved for non ambulatory. Bedroom #4 approved for Bedridden. Hospice waiver approved for six(6) residents. LPA Wesley conducted a complete tour of the facility and utilized the Compliance and Regulatory Enforcement (CARE) tools for the todays visit. LPA observed the supply of food, Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA Wesley observed the fire extinguisher in the kitchen area to be fully charged and serviced. The water temperature was tested and measured 116.6 degrees F. The Last fire drill was conducted on 12/04/24. LPA Wesley interviewed 2 residents and 2 staff. The smoke detectors/carbon monoxide detector are operable. The Liability insurance is current expires on 04/26/25. The Administrators certificate for Lourdes Bisnar Certificate 7005767740 expires 8/9/26. There is one citation cited in accordance to the California Code of Regulations, Title 22. Exit interview conducted, and a copy of the report was given to Lourdes Bisnar.the state’s words, verbatim · CDSS document, Feb 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and was greeted by Lerma Dongley (caregiver) and Edjeska Macandili (licensee) who assisted with the visit. The purpose for today’s visit was explained. The facility is licensed to serve 6 elderly residents ages 60 and above, with bedrooms 1,2,3 approved for non-ambulatory and bedroom 4 approved for bedridden. There is a hospice waiver for 6 residents. The facility is a single-story home located in a residential area in Norwalk, Ca. A tour of the facility includes: living room, kitchen, dining area, 4 bedrooms (2 double and 2 single), 2 bathrooms (1 bathroom located in resident room), front yard, back yard, attached garage with laundry. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan, Dementia Plan and training, and facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for residents. The hot water temperature was tested throughout the facility and measured outside of the required range of 105-120 degrees F, water temperature in main resident restroom tested at 123.2 degrees F and water temperature tested within resident bedroom (jack and jill sinks) measured at 128.3 degrees F, details will be documents on the 809-D. (Continued on 809-C) All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Last fire/disaster/earthquake drill was conducted on 11/2/23. Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, Alzheimer’s and Dementia, medication assistance, and other ongoing training are documented in personnel files. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities, that may be subject to change depending on the weather. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. There is a back up freezer at sister facility next door that LPA also observed during visit. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed 4 residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are currently no bedridden residents at the facility, however, licensee is aware of the reporting requirements when admitting a bedridden resident. Facility has recommended documents on residents with home health services and have ongoing communication with home health agencies. Facility admits residents with dementia and staff have all required training documented within personnel files. Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during today’s visit are documented on the 809(D). Exit interview held and a copy of the report was provided to Edjeska Macandili.the state’s words, verbatim · CDSS document, Dec 18, 2023