Maison for Mom

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by staff at 8am and met with House Manager (HM) Joyce Cornejo. LPA explained the purpose of the visit. Both Administrators Laura Oudinot and Shelly Yamashiro arrived at 8:30 to 9am but were unable stay the entire visit. The facility is a five bedroom, two bathroom single story home with an approved fire clearance of six non-ambulatory residents and a hospice waiver for six. Currently there are six residents in care with two residents on hospice. The garage has been recently converted to an additional dwelling unit with a separate address of 802 W. Brentwood Avenue and was permitted by the city in April 2026. During today's visit, LPA toured the physical plant and observed two residents reclining in the living room. The living room fireplace has protective mesh. There are two refrigerators in the kitchen and the facility retained a minimum of two days perishable food items and seven days of non perishable food items. The fire extinguishers was charged and were tested on September 16, 2025. The smoke and carbon monoxide detectors were inspected and tested and detectors were operational. The last fire drill was conducted on June 1, 2026. The facility temperature was 76 degrees Fahrenheit. LPA tested two of two bathrooms and the hot water temperatures ranged from 105.0 to 105.2 degrees Fahrenheit. Chlorox and cleaning supplies were observed in the first bathroom and a citation will be given. LPA toured resident bedrooms and all rooms had the required linens and furniture. No medications were observed in resident rooms and centrally stored medications were secured and reviewed. Per review, medications are being given as prescribed. (Continued on LIC 809-C) (Continued from LIC 809) LPA toured the exterior of the property and observed one sliding door screen needed repair and a deficiency will be given. A shaded seating area was available for residents and pathways were clear of obstructions. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. One of six resident files needed an updated Medical Assessment which Administrators are working on obtaining. A deficiency will be cited. The certificate of liability insurance was current and will expire on July 31, 2026. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on October 6, 2027. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Joyce Cornejo, House Manager and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, Jun 30, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Joyce Cornejo and the purpose of the inspection was discussed. Administrator (AD) Shelly Yamashiro was contacted by phone and arrived at approximately 10:00 a.m., however was unable to stay for the entirety of the inspection due to a private appointment and left at approximately 11:00 a.m. During the inspection, LPA and Staff Cornejo conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a one-story home with four resident bedrooms, one staff room, two bathrooms, living room, dining room, kitchen, and attached two-car garage. In an unlocked kitchen cabinet, LPA observed staff’s own personal medication and supplements; a Deficiency was cited on today’s date. In the garage, LPA observed a bed, made with linen, blankets, and pillows, and staff's personal belongings, including clothing and shoes; a Deficiency was cited on today’s date. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets. The backyard has a shaded sitting area. LPA observed residents having lunch and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested at 158.3 degrees Fahrenheit; a Deficiency was cited on today’s date. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food a required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with service tag dated September 16, 2025. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. (Cont. LIC809-C) Residents’ medication was observed to be centrally stored and locked. LPA conducted review of Medication Administration Records (MARs) and select residents’ medication. LPA reviewed five of five resident files and three staff files. LPA interviewed select residents and staff. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: Staff did not provide medication assistance to resident in care Facility is not kept clean

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced inspection visit to deliver findings for complaint investigation into the above allegations. LPA explained the reason for the visit with Administrator Nicolas Oudinot and Licensee Francis Meija. During the course of the investigation LPA toured facility, reviewed records, conducted interviews with residents & staff, made observations and requested pertinent documentation such as resident roster, resident appraisal, needs &service plan, and physician’s report. In regards to allegation “Staff did not provide medication assistance to resident in care”, During investigation LPA Reviewed files, conducted interviews and made observations. LPA reviewed resident records and observed that one of six residents (Resident 1) did not have a Medication Administration record on file. LPA observed that Facility had a medication list for resident 1 but no logs notating when medications are administered. LPA observed R1’s Physician report and Appraisal notated resident is not able to administer own medications and requires assistance with medications. CONTINUED ON 9099C Substantiated Interviews with staff revealed that Staff 1 administers medications to Resident 1 for the day however Staff 1 mentioned that Resident 1 had medications previously in a safe inside bedroom and would give staff approval to assist with meds. Staff1 states they did not have access to medications to create list. Interview with Resident 1 revealed that staff did not provide medications at proper scheduled time. Interview with Resident 1 revealed that incident regarding assistance with medications happened a couple of times. During visit LPA observed medications for residents were locked in a secure location and based off medication list Resident 1’s medications were accounted for. Resident 1 had over the counter supplements which did not observe a written physician’s order. In regards to allegation “Facility is dirty”, LPA observed the following, Facility had cracked floor near bedroom 1, a missing cupboard drawer in kitchen area, and a large hole in Resident 1’s dresser. LPA observed additional clutter and facility items piled up in backyard. Interviews with staff revealed that items located outside are scheduled for trash pick up for later in the month. Based on records reviewed , observations made and interviews the preponderance of evidence has been met, deeming the allegations staff did not provide medication assistance to resident in care and facility is dirty is deemed SUBSTANTIATED. The following deficiencies are being cited per Title 22. Licensee Francis Mejia and Administrator Nicolas Oudinot needed to leave during visit and assigned caregiver Joyce Cornejo to sign on their behalf. An exit interview was conducted with caregiver Joyce Cornejo and a copy of this report and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Feb 7, 2025 · control 22-AS-20250203140840

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(6) · Plan of correction due date: Feb 21, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by based off record review, facility does not have a Medication Administration Record for one of six residents. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 7, 2025

Plan of correction: Licensee to provide inservice training for staff and provide Medication Administration Records for all residents in care. Licensee to provide proof of POC by due date 2/21/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 21, 2025

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Facility has broken drawers, cracked floor and multiple clutter in backyard. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 7, 2025

Plan of correction: Licensee to address repairs for facility to be in complainace. Licensee has scheduled trash pick up for items in backyard. Licensee to provide proof of POC by due date 2/21/25

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after explaining the purpose of the visit. Facility administrator Shelly Yamashiro was notified by telephone and arrived later to assist. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with two private rooms, two shared room and one staff room in addition to the facility's common living areas. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. The backyard has a shaded area and the routes of egress are free of clutter and obstructions. There are currently six residents admitted to the facility with two residents receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Combined smoke and carbon monoxide detectors tested operational. Fire extinguisher present is observed to be fully charged with up-to-date maintenance. During the tour of the physical plant, potentially dangerous items such as bleach and insecticide were observed to be accessible and later secured by staff, resulting in deficiency being cited. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed six resident files and seven staff files as well as conducted two staff and two resident interviews. Based on the observations made during today’s inspection, one type A deficiency is being cited per Title 22 Division 6 of the California Code of Regulations along with three technical advisory notes. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 12, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.