Magnificent Manor

Type of visit: Required - 1 Year

On 01/16/26, Licensing Program Analyst, Wendy Gibbs, conducted an unannounced 1-year Required Annual Visit to the facility listed above using the full CAREs tool. LPA met with Nadine ‘Susana’ Sibayan, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) non-ambulatory clients, age sixty (60) and over, four (4) of which may be bedridden, with an approved hospice waiver of four (4). There are currently six (6) residents residing in the facility. Files The LPA reviewed six (6) resident files and found they contained the required documents. The LPA reviewed the Administrator and three (3) staff files and found they contained the required documents, training, and certification. LPA observed the administrator’s Administrator Certificate #7015514740 is valid till 04/02/2026, During record review, LPA observed licensing fees are current. Medication LPA observed all Centrally Stored Medications secured in a locked cabinet in hall and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed the medication and Medication Administration Record (MAR) for six (6) residents. LPA observed six (6) out of six (6) resident’s MARs and medication are consistent with properly documented records. Safety The LPA observed smoke detectors and carbon monoxide were operable. The LPA observed a fully charged fire extinguisher last serviced on 07/08/25. The last Fire Prevention Inspection was last conducted on 07/11/25, by the Torrance Fire Department. The last emergency drill was conducted on 09/25/25. LPA observed all exits clearly marked. LPA observed the Emergency Disaster Plan (LIC610E) posted and last updated on 02/21/2025. The facility has a working landline telephone. LPA reviewed and received a copy of liability insurance through Allied Health that is valid till 03/06/26. LPA inspected the First Aid Kit and found it contained the required items and a current manual. The LPA observed all mandated signs and documents posted throughout the facility. Infection Control During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station, and visitors log upon entry. LPA observed it has hand sanitizer, masks, gloves, sanitizing wipes, and a thermometer available. All mandated infection control signs were posted throughout the facility. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. LPA was unable to complete the annual inspection during today’s visit and will return to complete the inspection on a later date. An exit interview was conducted with Assistant Administrator Nadine ‘Susana’ Sibayan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Required - 1 Year

On 01/10/25, the department conducted an unannounced annual visit to the facility listed above using the full CAREs tool. The department met with Licensee, Joseph Sol, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory clients, age sixty (60) and over, of which four (4) may be bedridden, with a hospice waiver of four (4). There are currently four (4) residents residing in the facility. Physical Plant/Structure The facility is a single-story home located in a residential neighborhood. It consists of the following: five (5) resident rooms, two (2) bathrooms, living area, dining area, kitchen and outside covered patio area with a table and chairs. There is a detached garage which is used for storage. The garage contains the washer and dryer for laundry, and a freezer and refrigerator. There were no bodies of water on the premises. The department observed all walkways outside of the home to be clean, clear, and free of obstructions, hazards, and debris. Bedrooms The department inspected all bedrooms and found them to be clean and in good repair. The department observed all bedrooms to have the required furniture, including bed(s), dresser(s), nightstand(s), chair(s), and ample storage space for resident’s personal belongings. The department observed the beds have (1) CONTINUED ON LIC-809C the required linens, including a mattress cover, fitted sheets, blanket, comforter, and pillows. All bedrooms were observed with ample lighting. The department observed an ample supply of bed linens, blankets, and comforters stored in the hall cabinet, in good repair. Bathrooms The department inspected both bathrooms and found them to be within Title 22 regulations and were clean and operational. The department observed showers have a non-skid mats, shower chair, and secured safety handrails. The department observed an ample supply of towels, hand towels, and wash cloths in the hall cabinet, in good repair. The department observed resident’s hygiene boxes and an additional supply secured in a locked cabinet in the bathroom and are inaccessible to residents. The water temperature measured 114.1-degrees and 118.8-degrees Fahrenheit. Kitchen The department inspected the kitchen and found it to be clean and sanitary. All appliances were observed to be operational and in good repair. The department observed an ample supply of cookware, dining ware, and cutleries. The department observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. An additional supply of canned foods and a freezer were observed in the garage. The department observed all cleaning supplies secured in a locked cabinet under the kitchen sink. All knives and sharps were observed secured in a locked drawer in the kitchen. The water temperature measured 111.4-degrees Fahrenheit. (2) CONTINUED ON LIC908-C Common Rooms The department observed the facility to be sanitary and appropriately furnished at the time of visit. The department observed games and activities stored in a cabinet in the living room. The living area has a couch, two (2) recliner, and two (2) chairs available for resident use. The dining room has a large table and chairs to accommodate residents. The department observed all rooms and hallways had ample lighting. The department observed all walkways and hallways inside the facility to be clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature. Safety The department observed smoke detectors and carbon monoxide were operable. The department observed a fully charged fire extinguisher last serviced on 07/029/24. A Fire Prevention Inspection was last conducted on 07/29/24, by the Torrance Fire Department. The last emergency drill was conducted on 10/15/24. The department observed all exits clearly marked. The facility has a working landline telephone. The department reviewed and received a copy of liability insurance through Allied Health that is valid till 03/06/25. The department inspected the First Aid Kit and found it contained the required items and a current manual. Files The department reviewed four (4) resident files and found they contained the required documents. The department reviewed the Administrator and three (3) staff files and found they contained the required documents, training, and certification. During record review, the department observed licensing fees are (3) CONTINUED ON LIC809-C current. The department observed all mandated signs and documents posted throughout the facility. Medication The department observed all Centrally Stored Medications secured in a locked cabinet in hall. All medications were observed in their original packaging. The department reviewed the medication and Medication Administration Record (MAR) for four (4) residents. The department observed resident’s MARs and medication are consistent with properly documented records. Infection Control During the visit, the department observed the facility infection control practices. The department observed a sanitizing station and visitor log upon entry. The department observed it has hand sanitizer, masks, gloves, and a thermometer available. The department observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated infection control signs were posted throughout the facility. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the department did not observe any deficiencies, therefore no citations were issued at this time. An exit interview was conducted with Licensee, Joseph Sol, and a copy of this report was provided. (4)the state’s words, verbatim · CDSS document, Jan 10, 2025

Allegation investigated: Staff did not seek timely medical attention for a resident. Staff did not have accurate records for a resident. Staff did not address a resident's change in medical condition. Staff administered unauthorized medications to a resident. Staff did not provide adequate care and supervision to a resident.

On 04/04/24, at 10:30am, Licensing Program Analysts (LPAs) Perry Scott and Troy Watson conducted a subsequent unannounced visit to the facility and was greeted by Joseph Sol, Licensee. LPAs explained the purpose of this visit is to gather additional information and deliver findings for the allegations mentioned above. The investigation consisted of the following: An initial complaint visit was completed by LPA Jeremiah Randle on 01/13/2023. A subsequent visit was completed by LPA Perry Scott and Troy Watson on 04/04/2024. LPAs investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S3) and residents (R1-R4). Resident Roster (Dated 08/28/2023) Staff Roster (Dated 01/01/2023), Admission Agreement (Dated 04/14/2020), Needs and Service Plan (Dated 05/27/2021), Face sheets/ID and Emergency Information (Dated 08/09/2022), Pre-Appraisal (Dated 04/14/2020), Physician's Report (Dated 07/04/2022), MAR (Dated October -January 2023), Unusual Incident Report (Dated 01/04/2023), Daily Monitoring Record (Dated October 2022 -January 2023), and Hospice Discharge Notification (Dated 01/04/2023) for R1 were obtained from the facility. Report continued on LIC 9099-C Unsubstantiated The investigation revealed the following: Allegation #1 Staff did not seek timely medical attention for a resident. The details of the complaint alleged that the facility did not seek timely medical attention for the resident and that the resident was in severe pain. It was reported that the staff stated the resident was transitioning and only contacted hospice. On 04/04/24, from 10:30am-2:00pm, LPA interviewed staff (S1-S3) and residents (R1-R4) regarding the allegation. R1 could not be interviewed because R1 has moved to another facility and was not cognitively coherent to answer pertinent questions. 3 of 3 staff denied the allegation Staff did not seek timely medical attention for a resident. S1-S3 stated that all residents receive timely medical attention and that every measure is taken to ensure that medical needs are met according to their care plan. Staff further state that when residents are on hospice, they can only call the hospice agency and are only given comfort measures. Staff stated that on 01/03/2023 the hospice agency was notified, and the family was too because R1 was in severe pain. LPA reviewed the SIR (Dated 01/04/2023) submitted by the facility and did not find any discrepancies in the time it took to notify the proper authorities of the residents’ medical issues in a timely manner. LPA further reviewed the hospice plan of care (Dated 12/02/2022) that allowed for a comfort kit (morphine sulfate 20mg/0.25ml) if the resident was in pain. LPA interviewed R1-R4 about the allegation that the Staff did not seek timely medical attention for a resident. 3 of 4 residents that were interviewed stated that when medical attention is needed the facility gives them timely medical attention and that they are satisfied with the care and supervision given by the staff. Based on interviews and records reviewed there is insufficient evidence to support the allegation that Staff did not seek timely medical attention for a resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 2- Staff did not have accurate records for a resident. The details of the complaint alleged that the facility did not have accurate medication records for the resident in care. On 04/04/24, from 10:30am-2:00pm, LPA interviewed staff (S1-S3) and residents (R1-R4) regarding the allegation. R1 could not be interviewed because R1 has moved to another facility and was not cognitively coherent to answer pertinent questions. 3 of 3 staff denied the allegation that Staff did not have accurate records for a resident. S1-S3 stated that R1s records were up to date. LPA reviewed R1’s Medication Administration Record (Dated October -January 2023), Physicians Report LIC602 (Dated 07/04/2022), Daily Monitoring Record (Dated October 2022 -January 2023), and Hospice Plan of Care (Dated 12/02/2022) and did not find any discrepancies in R1’s record. LPA interviewed R1-R4 about the allegation and 3 of 4 residents that were interviewed denied the allegation that Staff did not have accurate records for a resident. Residents stated that they believe that all records were accurate and that they believed that the facility had up to date records of their medical issues. Report continued on LIC 9099-C Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not have accurate records for a resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 3- Staff did not address a resident's change in medical condition. The details of the complaint alleged that the facility did not address the residents change in condition because the resident was in pain, with family members. On 04/04/24, from 10:30am-2:00pm, LPA interviewed staff (S1-S3) and residents (R1-R4) regarding the allegation. R1 could not be interviewed because R1 has moved to another facility and was not cognitively coherent to answer pertinent questions. 3 of 3 staff denied the allegation that Staff did not address a resident's change in medical condition. All staff stated that any change in a resident’s condition would be immediately addressed with the family, hospice, and the primary physician as it was done in this case. S1 stated that S1 contacted the family member and told them that R1 was not eating well and had a poor appetite, and that the hospice nurse was visiting R1 to monitor R1’s condition. S1 further explained to the family member that R1’s blood pressure and oxygen levels were not in the normal range and that the hospice agency was contacted to oversee R1’ condition. S1 stated that when R1 was in pain the hospice nurse would administer morphine as a comfort measure. LPA reviewed the hospice plan of care (Dated 12/02/2022) and found that skilled nursing visited R1 twice per week and administered PRN, if change in status, as needed. As well as a Home Health Aide that also visited twice per week; the plan entails bathing, dressing, toileting, transferring/ambulation, hydration, grooming, medication administration, and assist and encourage food intake. LPA interviewed R1-R4 about the allegation and 3 of 4 residents that were interviewed denied the allegation that the Staff did not address a resident's change in medical condition. Residents stated that the staff are responsive and inform the family, hospice, or their primary care physician, if changes are detected in their medical condition. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not address a resident's change in medical condition. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 4- Staff administered unauthorized medications to a resident. The details of the complaint alleged that the facility administered unauthorized morphine medications to the resident while in care. On 04/04/24, from 10:30am-2:00pm, LPA interviewed staff (S1-S3) and residents (R1-R4) regarding the allegation. R1 could not be interviewed because R1 has moved to another facility and was not cognitively coherent to answer pertinent questions. Report continued on LIC9099-C 3 of 3 staff denied the allegation that Staff administered unauthorized medications to a resident. All staff stated that they did not administer any unauthorized medication that was not authorized by hospice. LPA reviewed the hospice plan of care (Dated 12/02/2022) and hospice medication list (Dated 01/02/2023) and found that R1 was prescribed morphine sulfate 20mg/0.25ml as needed, if R1 was in pain. LPA interviewed R1-R4 about the allegation and 3 of 4 residents that were interviewed denied the allegation that the Staff administered unauthorized medications to a resident. Residents stated that they did not have any issues with the staff giving them unauthorized medications from their primary care physicians. They stated that all medications were authorized from their primary care physicians and were satisfied with the care and supervision provided by the staff. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff administered unauthorized medications to a resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation # 5- Staff did not provide adequate care and supervision to a resident. The details of the complaint alleged that the facility did not provide adequate supervision and care to the resident because the resident was in pain. On 04/04/24, from 10:30am-2:00pm, LPA interviewed staff (S1-S3) and residents (R1-R4) regarding the allegation. R1 could not be interviewed because R1 has moved to another facility and was not cognitively coherent to answer pertinent questions. 3 of 3 staff denied the allegation that Staff did not provide adequate care and supervision to a resident. S1-S3 stated that the resident received regular medical attention, care, and supervision by the staff, and the hospice agency. There was a hospice care team that came weekly, according to the hospice plan of care (Dated 12/02/2022) and staff that assisted with the residents’ activities of daily living, according to the daily monitoring logs (Dated October 2022-January 2023). LPA reviewed the Physicians Report (Dated 07/04/2022) and the Medication Administration Report (Dated October 2022-January 2023) and found that R1 was getting regular visits from a physician and was getting regular medication. LPA interviewed R1-R4 about the allegation and 3 of 4 residents that were interviewed denied the allegation that the Staff did not provide adequate care and supervision to a resident. 3 of 4 residents stated that they were getting adequate care and supervision from the staff. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not provide adequate care and supervision to a resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted with Joseph Sol, Licensee, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 3, 2024 · control 11-AS-20230109123320

Type of visit: Required - 1 Year

On 01/12/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above using the full CAREs tool. LPA met with Licensee, Joseph Sol, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory clients, age sixty (60) and over, of which four may be bedridden, with a hospice waiver of four (4). There are currently five (5) residents residing in the facility. Physical Plant/Structure The facility is a single-story home located in a residential neighborhood. It consists of the following: five (5) resident's rooms, two (2) bathrooms, living area, dining area, kitchen and outside covered patio area with a table and chairs. There is a detached garage which is used for storage. The garage consists of the washer and dryer for laundry. There were no bodies of water on the premises. LPA observed all walkway outside of the home to be clean, clear, and free of obstructions, hazards, and debris. Bedrooms LPA inspected all bedrooms and found them to be clean and in good repair. LPA observed all bedrooms to have the required furniture, including bed(s), dresser(s), nightstand(s), chair(s), and ample storage space for resident’s personal belongings. LPA observed the beds have the required linens, including a mattress cover, fitted sheets, blanket, comforter, and pillows. All bedrooms were observed with ample lighting. LPA observed an ample supply of bed linens, blankets, and comforters stored in the hall cabinet, in good repair. Bathrooms LPA inspected both bathrooms and found them to be within Title 22 regulations and were clean and operational. LPA observed showers had a non-skid mat and secured safety handrails. LPA observed an ample supply of towels, hand towels, and wash cloths in the hall cabinet, in good repair. LPA observed resident’s hygiene boxes and an additional supply secured in a locked cabinet in the bathroom and are inaccessible to residents. The water temperature measured 115.1-degrees and 115.6-degrees Fahrenheit. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed an ample supply of cookware, dining ware, and cutleries. LPA observed a 3-day supply of perishable foods and a 7-day supply on non-perishable foods properly stored, packaged, and labeled. An additional supply of canned foods and a freezer were observed in the garage. Continued on LIC809-C LPA observed all cleaning supplies secured in a locked cabinet under the kitchen sink. All knives and sharps were observed secured in a locked drawer in the kitchen. The water temperature measured 109.2-degrees Fahrenheit. Common Rooms LPA observed the facility to be sanitary and appropriately furnished at the time of visit. LPA observed games and activities stored in a cabinet in the living room. LPA observed all rooms and hallways had ample lighting. LPA observed all walkways and hallways to be clean, clear, and free of debris, obstructions, and hazards. The facility was maintained at a comfortable temperature. Safety LPA observed smoke detectors and carbon monoxide were operable. LPA observed a fully charged fire extinguisher last serviced on 07/08/23. A Fire Prevention Inspection was last conducted on 02/02/23, by the Torrance Fire Department. The last emergency drill was conducted on 12/15/23. LPA observed all exits clearly marked. The facility has a working landline telephone. LPA reviewed and received a copy of liability insurance through Allied Health that is valid till 03/06/24. LPA inspected the First Aid Kit and found it contained the required items and a manual. Files & Interviews LPA reviewed five (5) resident files and found they contained the required documents. During interviews with residents, they were happy with the services they receive at the facility. LPA reviewed the Administrator and three (3) staff files and found they contained the required documents, training, and certification. During interviews with staff, they were able to answer questions regarding policy and procedure, and resident care and rights. LPA observed all mandated signs and documents posted throughout the facility. Medication LPA observed all Centrally Stored Medications secured in a locked cabinet in hall. All medications were observed in their original packaging. LPA reviewed the medication and Medication Administration Record (MAR) for three (3) residents. LPA observed resident’s MARs and medication are consistent with properly documented records. Infection Control During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated infection control signs were posted throughout the facility. LPA did not observed or cite any deficiencies. An exit interview was conducted with Licensee, Joseph Sol, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 12, 2024

Allegation investigated: Staff do not ensure that the facility is free from pests. Staff do not ensure that residents is provided with activities. Staff do not ensure that residents is provided with an appropriate variety of foods. Staff are isolating residents.

On 10/11/23, Licensing Program Analyst (LPA), Wendy Gibbs, initiated an complaint investigation at the faciltiy listed above. During today's visit LPA met with Administrator, Minda Mcnamara, and explained the purpose of today's visit. During today's visit LPA toured the facility, interviewed staff (S1-S4) and residents (R1-R6) and received documents pertinent to the investigation. Documents received and rewiewed were Staff Roster, Resident Roster, Menu, Resident Admission Agreement, Physician Report, Pre Apprisail, Needs and Service Plan, and receipts from exterminator company. Continued on LIC9099-C Unsubstantiated Allegation: Staff do not ensure that the facility is free from pests. The allegation alleges that there are flies and gnats flying around the facility and in the dining area. During todays visit LPA did not observe any insects in the facility. LPA observed two meals served at the facility and did not see any insects in the dining room or kitchen. LPA reviewed documents from the exterminator company that comes monthly. During interviews with staff (S1-S4) four out of four stated they have not seen any insects flying around the facility and the facility is treated monthly for any insects. During interviews with residents (R1-R6) five out of six stated they have not seen any insects in the facility, and one out of six stated they have seen a fly a few times in the facility. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff do not ensure that residents are provided with activities. The allegation alleges that residents mostly just sit in their rooms all day, every day because staff do not provide activities. LPA observed residents with a daily newspaper and other materials to read. LPA observed a karaoke book and set up, in the living room available for residents. LPA observed games, activities, and reading material available for residents located in the living room. During interviews with staff (S1-S4) four (4) out of four (4) stated they offer activities, exercise, and outside activities like a walk to residents and encourage them to participate. Three out of three Staff (S2, S3 and S4) stated there are a few residents who choose not to participate in activities. During interviews with Residents (R1-R6) six out of six stated there are activities offered by staff at the facility. Residents (R1, R3, and R5) three out of three stated they do not usually participate in activities because they don’t want to. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Continued on LIC9099-C Allegation: Staff do not ensure that resident is provided with an appropriate variety of foods. The allegation alleges that staff give resident the exact same thing to eat every day. During visit, LPA observed breakfast and lunch at the facility, residents had a variety of food to eat. LPA reviewed the sample menu and weekly menu posted and observed a variety of foods provided to residents. During interviews with staff (S1-S4) four out of four stated food is prepared before every meal, and everything they use is fresh. Staff stated they do not serve food left over from previous meals or the same foods every meal. Staff (S2, S3, and S4) stated they have a resident that they make food special for every day because the resident wants what they like. During interviews with residents (R1-R6) five out of six residents stated they get a variety of foods. One out of six residents stated they need soft food otherwise it upsets their stomach, and the staff makes them what they like to eat. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff are isolating resident. The allegation alleges that staff do not ensure all residents are taken to communal areas for socialization. LPA observed residents in the dining room visiting and drinking coffee or water. Additionally, LPA observed five residents during lunch eating together. LPA observed R1 in their room and when asked why they were not in the dining room with the others R1 responded because I wanted to stay here. During interviews with staff (S1-S4) four out of four stated residents are encouraged to join other residents during meals and activities. Staff (S2, S3, and S4) three out of three staff stated there are a few residents that tell them “Not today,” when asked if they want to go to the living room, dining room, or outside. During interviews with residents (R1-R6) six out of six stated they are not isolated and have not been isolated. Residents R1 and R3 stated they do not always want to go to the living room or dining room and prefer to stay in their room. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator, Minda Mcnamara, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 11, 2023 · control 11-AS-20231006165632