Melos Care Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:30 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator Edwin Paul Oyasan arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a single-story home located in a residential neighborhood. INTERVIEWS: Starting at 9:35 a.m. and throughout the visit one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff is knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Residents stated that staff treat them well. COMMON AREAS: This includes living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 10:41 a.m. hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 09/18/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. Activities were observed in the common areas. The fireplace in the dining room was adequately screened, and noted to be non-functional. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were tested and observed to be functional at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are five (5) total bedrooms in the facility; four (4) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a shared, double occupancy resident room. There is no staff room and Administrator stated that staff remain awake at night. All five (5) bedrooms have exits to the exterior. All passageways were observed to be clear of obstructions. All rooms are set up with beds, nightstands, lamps, chests of drawers, chair/s and closet space. The beds are furnished appropriately. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. Each bedrooms have its own supply of linens stored in the closet. RESTROOMS: There are two (2) total restrooms. One (1) is designated as a shared / common resident restroom and One (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 119.8-120 degrees Fahrenheit, all within the required range. LPA discussed the regulatory standard of 105 -120 degrees Fahrenheit with Administrator as the water temperature was at the maximum. At the time if the visit Administrator adjusted the water temperature to ensure it was slightly below 120. LPA observed storage space closets in the laundry room containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 119.9 degrees Fahrenheit. Cleaning supplies and other chemicals are kept locked under the sink locked and inaccessible to residents in care. At 10:02 a.m. LPA observed a razor, and nail polish in an unlocked drawer in the kitchen, after review of all six (6) residents physician reports four (4) of six (6) residents physicians indicate that the following items could pose a danger which poses a potential health and safety risk to residents in care. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... LAUNDRY ROOM: LPA observed the locked laundry room adjacent to the office / staff lounge. Laundry room has a washer, dryer, laundry detergent and locked cleaning supplies. OFFICE: LPA observed the office which is adjacent to the living room. The office was observed to be locked and inaccessible to residents in care. The office was observed to contain locked cabinets that contained resident medications and facility files. Additionally, the office contained a locked refrigerator for resident medications and the facility’s complete first aid kit. LPA observed an additional fire extinguisher mounted on the wall to be serviced on 09/18/2025. BACKYARD: The entire property is fenced. The backyard has a patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. There are two (2) locked storage sheds in the back yard inaccessible to residents. RECORDS: Resident Records were reviewed beginning at 10:47 a.m. Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Pre- admission appraisal, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. During review LPA discovered two (2) of six (6) resident files to not have / updated needs and service plans. LPA provided education, technical violation. Personnel Records were reviewed beginning at 12:18 p.m. three (3) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. The infection control plan was reviewed on 10/02/2025 and the emergency disaster drill was updated on 03/25/2026. The last emergency disaster drill took place on ___/2025 and are conducted quarterly. Report Continued on LIC 809-C PAGE 4... (PAGE 4) Report Continued from LIC 809-C PAGE 3... MEDICATIONS: Medication review began at approximately 2:02 p.m. Medications are centrally stored and locked in the office / staff lounge adjacent to the living room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. Two (2) out of three (3) resident medications including PRNs were properly documented on the centrally stored medications and destruction record (CSMDR) which poses a potential health and safety risk to residents in care. At the time of the staff reviewed CSMDR and conducted a medication audit. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster. Administrator emailed LPA a copy of the Limited Liability insurance and the emergency disaster plan. At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator confirmed that all information is accurate. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:52 AM. LPA met with facility staff who contacted the facility Administrator Edwin Paul Oyasan. The Administrator arrived to the facility at 11:03 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 11:05 AM the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. The kitchen contained a locked under-sink cabinet containing cleaning supplies. COMMON AREAS: This includes the living room and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains activities for resident use. The dining area was observed to be equipped with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 11:44 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. Continued on LIC 809C. BEDROOMS: There are five (5) bedrooms in the facility; one (1) is a dual occupancy resident room and four (4) are single occupancy resident rooms. LPA and the facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All five (5) bedrooms contained a direct exit to the outdoors of the facility. BATHROOMS: There are two (2) bathrooms at the facility. One is designated as a shared/common resident bathroom and one is a private resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Both bathrooms contained locked under sink storage cabinets that contained resident grooming supplies and cleaning supplies. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. Water temperature was measured to be between 118.2 and 118.9 degrees Fahrenheit, which is within the range required by regulation. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed two (2) secured storage sheds that contained miscellaneous care supplies, paints, and gardening supplies. OFFICE: LPA observed the office to be locked and inaccessible to clients in care. The office was observed to contain locked cabinets that contained resident medications and facility files. Additionally, the office contained a locked refrigerator for resident medications and the facility’s complete first aid kit. LPA observed a fire extinguisher mounted on the wall to be serviced on 06/03/2025 GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. LPA observed the garage to contain extra cleaning supplies, emergency food and water supplies, and additional care supplies. Additionally, the garage contained an extra refrigerator. LPA observed an additional fire extinguisher mounted on the wall to be serviced on 06/03/2025. Continued on LIC 809C. RECORD REVIEW: Record review began at 11:45 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Two (2) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. Three (3) resident files, were observed to be missing records of their personal property inventory at the time of admission. LPA informed the Administrator who agreed to complete a personal property inventory for the identified individuals. MEDICATION REVIEW: Medication review began at 11:20 AM. Medications for two (2) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 05/30/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had concerns with the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse During today’s visit LPA obtained a copy of the facility’s resident roster and LIC 500. LPA attempted to obtain a copy of the facility’s current liability insurance. LPA was informed by the Administrator that the facility does not currently have active liability insurance. LPA informed the Administrator that facilities are required to maintain active liability insurance while in operation. The Administrator expressed understanding and agreed to obtain active liability insurance and send proof to LPA. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management – Incident visit to the above facility. The LPA met with Administrator Edwin Paul Oyasan. Entrance interview conducted. The reason for today's inspection is to follow up on a self-reported incident report that was received at the Woodland Hills Regional Office on 03/26/2025. Incident report indicates that on 03/25/2025, Resident #1 (R1) was found on the sidewalk outside a neighbor's home. 9-1-1 was called, as R1 appeared to have fallen while outside the facility. R1 was transported via ambulance to the hospital. LPA called Administrator on 04/01/2025 for additional information and the incident was discussed via telephone at that time. During today's visit, the LPA reviewed R1's file and obtained copies of pertinent documents, LPA conducted staff interviews at 01:55PM and 02:04PM, interview with R1 at 02:15PM, Facility Administrator at 02:42PM, and LPA toured the facility with Administrator at 02:48PM. Record review revealed that R1 is unable to leave the facility unassisted. Staff were aware that R1 expressed they want to leave the facility and R1 had previously attempted to leave the facility unassisted. R1's physician's report indicates R1 requires assistance with toileting, however, on 03/25/2025, R1 was left in the restroom unsupervised. R1 walked down the hall, through the laundry room and staff office area and exited the home unnoticed. R1 then opened the side gate and exited the facility property unsupervised. R1 walked down the sidewalk and appeared to have fallen by the neighbor's house. Further medical treatment was required at the hospital, as R1 sustained injury during the elopement incident. Pursuant to Title 22 CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided via email.the state’s words, verbatim · CDSS document, Apr 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Apr 9, 2025

(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section, as staff were aware R1 is at risk of elopement and has unsteady gait and R1 was left unsupervised, which resulted in R1 eloping and sustaining injury, which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 2, 2025

Plan of correction: Administrator stated additional supervision has been provided to R1 since returning to the facility. Administrator agreed to complete a new needs and service assessment for R1 and indicate what steps will be taken when R1 expresses a desire to exit the facility. Licensee also agreed to install a lock to the interior laundry room door and possibly an auditory device to the exterior exit gate. Proof of stated items will be sent to CCLD by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Paul Oyasan arrived shortly thereafter. The LPA and the Administrator began the tour of the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The LPA observed required postings throughout the common space. COMMON AREAS: Living room and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is covered with a screen and inaccessible. The facility maintained a comfortable temperature of 78 degrees. Smoke detector(s) and carbon monoxide detector were tested at 12:45 p.m. and operational at the time of the visit. The fire extinguisher observed fully charged; last serviced 5/2023. Administrator shall contact the company to have the extinguisher serviced or purchase a new one. BEDROOMS: There are (5) five bedrooms in the facility; the facility has (4) four private bedrooms for resident use and (1) shared bedroom for resident use there is no staff room, and the facility has a den that is used as office space for staff. All resident rooms have direct access to the outside. Lighting in the rooms appeared adequate. Resident rooms were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. BATHROOMS: There are (2) two full bathrooms; one bathroom is located in Bedroom #1 and the 2nd bathroom is located in the main hallway; showers are equipped with grab bars and nonskid mats. KITCHEN: Knives and cleaning supplies observed to be inaccessible at the time of visit. Over the counter medication, vitamins and supplements observed accessible in kitchen cabinet. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Continued on LIC 809-C. The facility has an attached garage that is accessible through the kitchen, the garage contains additional refrigerator with perishable foods, additional nonperishable food supply, cleaning supplies, emergency water and mattresses. Administrator was reminded that staff should not be resting or sleeping in the garage as it is not fire cleared and not safe. Administrator was reminded that there is no designated staff room therefore 24hour awake staff is required. Administrator agreed to submit an update Lic 500 Personnel Schedule for 24hr staff coverage. LAUNDRY: The laundry area is located in a room between the main hallway and den/staff office. Laundry detergent and chemicals are stored inaccessible in a cabinet above the washer and dryer. Extra linens and towels are also kept in a cabinet in the laundry room. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single latched. No bodies of water noted and exit is free of obstructions. LPA observed several bulky items stored in the backyard. Administrator stated it belongs to the property owner. It was agreed that the backyard will be cleared out and these items will be removed from the backyard within two weeks. RECORDS: Resident records reviewed from approximately 1pm-2:30pm. Resident facility records observed complete. At approximately 3:30pm-5pm; Staff records reviewed observed to be incomplete, not limited to health assessments, appropriate training topics. LPA was unable to verify required training topics and hours for staff #1. Incomplete medication training. Staff #2 did not obtain fingerprint clearance and has been working at the facility since 5/2024. Civil penalties assessed. MEDICATIONS: Medications are in a locked cabinet in the staff office. The first aid supplies and a first aid manual were stored in the medication cabinet. Medication reviewed for two (2) out of five (5) residents at approximately 5pm-5:30pm. During the review it was observed that staff are writing on the residents medication prescription labels (start dates). Administrator did not have PRN authorization letter for residents with PRN medications. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 19, 2024

The state marks this report as 18 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.