Mercy Home 3

Allegation investigated: Staff does not ensure resident is allowed to have visitors at the facility.

On 8/19/2026 Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to commence the complaint investigation and deliver the findings of the above allegation. LPA explained the purpose of the visit to Administrator Mercillina Ajunwa. The investigation consisted of record reviews, interviews with the reporting party and staff as well as observation. Allegation: Staff does not ensure resident is allowed to have visitors at the facility. LPA did not find evidence showing facility staff restricted or prevented visitation. Interviews confirm visitation challenges were due to family disagreements and not facility action. Staff allowed RP to visit R1 during the investigation without issue. Based on interviews, observations, and record review, the allegations mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated at this time. An exit interview was conducted where this report LIC9099 was discussed and provided to Administrator Mercillina Ajunwa. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 19, 2026 · control 56-AS-20260615082319

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Mercilina Ajunwaand was granted entry to the facility. Licensed capacity is (6) current census (5). LPA was accompanied by Administrator Mercilina Ajunwaand, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents . Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident file for admission agreements, updated physician reports, and needs and services plans. LPA also verified (3) resident's medications, along with (3) Hospice files. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. During record review, LPA Rico observed (2) staff had an expire CPR/1st aid Certificate and observed the facility last emergency drill was conducted on March 20,2025. Futhermore, LPA recommoned Licensee to organize and label residents Pre-admission assessment and Reappraisals/Care Plan. Based on the observations made during today’s visit, (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Along with two technical violations. An exit interview was conducted, and this report (LIC809) (LIC809D)Appeal Rights was discussed and provided to Administrator Mercilina Ajunwaand.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Required - 1 Year

On 02/25/2025 at 02:15 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there were one (1) staff present, and four (4) residents present. Licensee/Administrator Mercillina Ajunwa was contacted and informed of the visit. Licensee/Administrator Ajunwa arrived during the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Ajunwa. The facility has 6 bedrooms, in which five (5) bedrooms are designated for residents, and one (1) bedroom's designated for staff, 3 and 1/2 bathrooms, living room, kitchen, dining area, backyard, laundry room and attached garage. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is four (4) residents. The facility has approved hospice waiver for four (4) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. The facility is maintained at a comfortable temperature of 68 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the residents/staffs shared bathroom to be at 105.2 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside the medication closet ***Continuation in LIC809C*** near the kitchen inaccessible to residents. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. LPA observed the facility have emergency supplies, food and water. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week and a night staff, awake and on duty at night for facility with dementia residents. Record Review: The facility has updated Liability Insurance and Infection Control Plan maintained at the facility. LPA reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medications list, needs and services plans. LPA Brown observed that Resident #2 (R2) Admission Agreement does not have the Licensee/Facility Representative Signature and no signature date. Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA observed Staff #2 (S2) working at the facility with criminal background clearance but S2's criminal background clearance was not transferred to the facility prior to employment on 11/2024. Deficiency will be issued and civil penalty of $500.00 will be assessed today, and will continue to be assessed of $100.00/day until corrected. Medications/MARs records were audited for two (2) residents and appeared to be dispensed and logged appropriately. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Mercillina Ajunwa.the state’s words, verbatim · CDSS document, Feb 25, 2025

Allegation investigated: Staff do not assist resident out of bed. Staff do not administer resident's medication as prescribed. The facility does not provide adequate meals to meet residents needs. Staff scolded resident. Staffs do not allow resident to wear their own clothes.

On 02/13/2025 at 04:30 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to deliver findings on a complaint investigation. LPA Brown was greeted and granted entrance to the facility by Licensee/Administrator Mercilina Ajunwa. LPA Brown explained the purpose of today's visit to Licensee/Administrator Ajunwa. The investigation was conducted by LPA Brown. The investigation consisted of file review, observations and interviews with relevant parties. The first allegation indicates staff do not assist resident out of bed. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with two (2) of two (2) residents indicated that staffs at the facility are assisting them out of bed. Two (2) of two (2) staffs interviewed reported that they are assisting their residents out of their bed. Interviews with two (2) of two (2) staffs revealed that Resident #1 (R1)'s two (2) persons assist and they are always assisting R1 out of bed. ***Continuation in LIC9099C*** Unsubstantiated R1 Hospice Care Nurse Director shared that the hospice care team did not report any incident that the staffs at the facility are not assisting R1 out of bed. In addition, R1 Hospice Care Nurse Director reported that the hospice care team did not report any neglect by a staff at the facility to R1 or other residents. Also, R1 Hospice Care Nurse Director indicated that R1 skin's dry, fragile, and R1 does not have enough nutrition which makes R1 high risk and prone for skin breakdown at any time and not from poor care of the staffs at the facility. During the facility visit on 07/22/2024, 12/03/2024 and 12/17/2024, LPA Brown observed staff assisting their residents out of bed. The second allegation indicates that staffs do not administer medications as prescribed. Interview with two (2) of two (2) residents indicated that staffs are giving their medications daily and administering their medications as prescribed by their physician. Two (2) of two (2) staffs interviewed reported that they are giving their residents medications per their doctor's order. Staff #1 (S1) reported to LPA Brown that there's no incident that happened at the facility that they placed two (2) medication patches on R1 and R1's family member cancelled the prescription. Interview with Hospice Care Nurse Director indicated that the hospice care team did not report staffs at the facility are not administering R1's medication as prescribed. During the facility visit on 07/22/2024, 12/03/2024 and 12/17/2024, LPA Brown noted that staffs at the facility are utilizing Medication Administration Record (MAR) to ensure that they are administering their residents medications as prescribed by their doctor. Moreover, LPA Brown audited two (2) residents medications on 12/03/2024 and observed that staffs at the facility are administering their residents medications as prescribed by their doctors. The third allegation indicates that the facility does not provide adequate meals to meet residents needs. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with two (2) of two (2) residents indicated that the facility's providing them adequate meals to meet their needs and they can get second serving of food if they prefer. Two (2) of two (2) staffs interviewed reported that they are serving their residents adequate meals everyday and there's no incident that they did not provide adequate meals to their residents and they did not meet their needs. Two (2) staffs interviewed shared that they are providing adequate meals for R1. Hospice Care Nurse Director informed LPA Brown that the hospice care team did not report an incident that the facility's not providing adequate meals to R1 and not meeting R1's needs. During the facility visit on 07/22/2024, 12/03/2024 and 12/17/2024, LPA Brown observed that the facility's serving adequate and nutritious meals to their residents to meet their needs. The fourth allegation indicates that staff scolded resident. Interview with two (2) of two (2) residents indicated ***Continuation in LIC9099C*** that there's no incident at the facility that a staff scolded and yelled at them. Two (2) of two (2) staffs interview reported that they never scolded R1 or their residents and they did not yell at R1 or their residents. Hospice Care Nurse Director stated that the hospice care team did not report an incident at the facility that a staff scolded or yelled at R1 or their other residents. During the facility visit on 07/22/2024, 12/03/2024 and 12/17/2024, LPA Brown observed that staffs at the facility are providing care and supervision to their residents and they are not scolding or yelling at their residents. The fifth allegation indicates staff do not allow resident to wear their own clothes. Interview with two (2) of two (2) residents indicated that they are wearing their own clothing that they prefer to wear and there's no incident at the facility that a staff did not allow them to wear their own clothes. Two (2) of two staff interviewed reported that their residents are wearing their own clothing. Interviews with two (2) of two (2) staffs revealed that they never restricted R1 or their residents to wear their own clothing. Hospice Care Director reported that the hospice care team did not report any incident that staffs at the facility are not allowing R1 or their residents to wear their own clothing. During the facility visit on 07/22/2024, 12/03/2024 and 12/17/2024, LPA Brown observed that residents at the facility are wearing their own clothes and staffs at the facility did not prohibit them from wearing their own clothes. Based on interviews and records review, the allegation that Staff do not assist resident out of bed (Allegation #1), Staff do not administer resident's medication as prescribed (Allegation #2), The facility does not provide adequate meals to meet residents needs (Allegation #3), Staff scolded resident (Allegation #4), Staffs do allow resident to wear their own clothes (Allegation #5) are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, where this report (LIC9099) was discussed and provided to Licensee/Administrator Mercilina Ajunwa.the state’s words, verbatim · CDSS document, Feb 13, 2025 · control 56-AS-20240206100424

Allegation investigated: Staff did not seek timely medical attention for a resident. Staff did not properly report an incident involving a resident.

On 12/17/2024 at 01:40 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to deliver the findings of the above allegations. LPA Brown was greeted and granted entrance to the facility by a staff. Licensee/Administrator Mercelina Ajunwa was contacted and arrived during the visit and met with LPA Brown. LPA Brown explained the purpose of today's visit to Licensee/Administrator Ajunwa. The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates staff did not seek timely medical attention for a resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with three (3) of three (3) staff indicated that they all seek timely medical attention for their residents if needed. Three (3) of three (3) staff indicated that on 07/13/2024, no incident happened to Resident #1 (R1) that R1 needs timely medical attention. Staff #1 (S1) informed LPA Brown that S1's Licensed ***Continuation in LIC9099C*** Unsubstantiated Professional and S1 reported to LPA Brown that S1 assessed R1 on 07/13/2024 after S1 observed R1's blinking R1's eyes for two (2) or three (3) seconds but it did not continue. S1 indicated that S1 did not observed any changes on R1 that will require immediate medical attention. Interviews with two (2) of two (2) residents indicated that staffs at the facility are seeking timely medication for them. LPA Brown unable to interview three (3) residents at the facility as one (1) resident is not oriented, one (1) resident with family, and one (1) resident was sleeping. The second allegation indicates staff did not properly report an incident involving a resident. Interview with three (3) of three (3) staff indicated that they are properly reporting all incidents involving a resident at the facility to their family, physician and Community Care Licensing Division (CCLD). S1 reported to LPA Brown that there's no incident that happened to R1 on 07/13/2024 that needs to be reported as no changes was observed to R1. S1 added that after R1's family visit on 07/13/2024, that same day, as a courtesy, S1 called R1's family/Power of Attorney(POA) and Fiduciary and S1 provided updates on R1's family visit to R1. R1 Family member/POA reported to LPA Brown that they are in close contact with S1 and all issues involving R1 were properly reported to them. Interviews with two (2) of two (2) residents indicated that staffs at the facility are reporting all incidents that are happening at the facility to their family. LPA Brown unable to interview three (3) residents at the facility as one (1) resident is not oriented, one (1) resident with family, and one (1) resident was sleeping. Based on interviews and records review, the allegations staff did not seek timely medical attention for a resident (Allegation #1) and staff did not properly report an incident involving a resident (Allegation #2) are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, where this report (LIC9099) was discussed and provided to Licensee/Administrator Mercelina Ajunwa.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 56-AS-20240715160448

Type of visit: Case Management - Deficiencies

On 07/22/2024, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a case management visit. LPA Brown was greeted and granted entrance by a staff. LPA Brown identified herself and discussed the purpose of the visit with Nicole Ajunwa. At the time of the visit, there were six (6) residents, and two (2) staffs present. During today's visit, LPA Brown observed that Resident #3 (R3) has full bed rail and staff interview and records review indicated that R3's not on hospice and no exception report was submitted and approved by Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office. Deficiency will be issued. Moreover, during the tour of the facility, LPA Brown observed Resident #2 (R2) and Resident #4 (R4), with half bed rails but staff interviews and document review indicated that there are no written order from their physician indicating the need for half bed rail for mobility. Deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D and Appeal Rights were discussed and provided to NIcole Ajunwa.the state’s words, verbatim · CDSS document, Jul 22, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jul 23, 2024

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do...(5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (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, record review, the licensee did not comply with the section cited above by having a full bed rail for Resident #3 (R3) and R3's not on hospice and no exception was submitted and approved to CCLD which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Licensee stated to remove R3's full bed rail and submit proof to LPA Brown on Plan of Correction (POC) due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(3) · Plan of correction due date: Aug 5, 2024

87608 Postural Supports (a) Based on the individuals preadmission appraisal....(3) A written order from a physician indicating the need for the postural support shall be maintained in the residents record. The licensing agency... This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by having Resident #2 (R2) and Resident #4 (R4), with half bed rails with no written order from their physician indicating the need for the postural support for mobility which poses a potential health, safety and personal rights risks to resident in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: The Licensee stated to submit written order from R2 and R4 physician indicating the need for the postural support for mobility and submit proof to LPA Brown on plan of correction (POC) due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Caregiver Margaret Muchangi and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is five (5) residents. LPA was accompanied by Caregiver to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility has three (3) residents (R2, R4, and R5) in care with a condition that requires auditory alarms on exterior exits. The facility does not have auditory alarms on the main entry door, the exterior sliding door leading into the backyard, and the exterior door in Resident R1’s bedroom. The facility will be issued a deficiency for not having auditory alarms on the facility exit doors. LPA measured and observed the water temperature in the bathrooms to be at 105 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident and staff files. Medications are kept inside the hallway cabinet inaccessible to residents. Non-perishable and perishable food supply is sufficient for the residents in care. Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA reviewed five (5) residents files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, and LIC811 were discussed and provided to Caregiver Margaret Muchangi, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jan 5, 2024