Mercy Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrew Martinez made an unannounced visit to the facility. The purpose of today's visit was to conduct the required annual comprehensive inspection. LPA met with Licensee Mercillina "Mercy" Ajunwa and was granted entry to the facility. The facility is Residential Care Facility for the Elderly (RCFE) operating in the capacity approved by the Community Care Licensing Division (CCLD). The facility is licensed for a capacity of six (6) non-ambulatory residents, of which (1) may be bedridden; current census is (0). LPA Martinez was accompanied by Licensee Mercillina "Mercy" Ajunwa to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is a two (2) story house with five (5) bedrooms, (3) bathrooms, kitchen, dining area, living room, office and an attached (3) car garage. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 77 degrees F. LPA inspected residents bedrooms; all equipped with required furniture such as mattresses, nightstands, storage space, and sufficient lighting. LPA inspected all bathrooms and were found to be 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. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. Postings such as facility licence, administrator's certificate, personal rights, emergency numbers, and disaster plans were posted in a common area. The RCFE Complaint Poster (PUB 475) is posted in the facility as well, however, does not meet the 20" x 26" regulation size requirements. A Technical Violation is being cited. *** Continued on LIC 809-C *** Food Service: Nonperishable and perishable food storage is adequate for the maximum capacity of residents in care. As current census is (0), Licensee is not currently storing food at this time. Dining area is equipped with sufficient seating for residents in care. Tableware (e.g., dishes, cups, utensils) are sufficient in numbers and stored properly. Yards/Outside: There is (1) enclosed shaded patio located at the back of the house and (1) partially enclosed shaded porch at the front of the house. There are (2) self-latching side gates on either side of the house that lead in and out of the backyard. Care & Supervision: Facility currently has sufficient staff coverage for twenty-four hour care and supervision. Record Review: LPA reviewed (1) staff files for First Aid/CPR certification, background/fingerprint clearance/exemption, health screening, and training verification. Miscellaneous: Licensee informed LPA they have temporarily suspended the facility's telephone service while there are no resident's in care. Licensee is to notify LPA/Licensing when telephone service is reestablished prior to moving in new resident(s). A Technical Advisory is being issued. LPA observed (2) window screens to Bedroom B and (1) window screen to Bathroom 2 having holes that require repair. A Technical Violation is being issued. Based on record review and observation made during today’s visit, (1) Technical Advisory and (2) Technical Violations were issued per Title 22, Division 6, of the California Code of Regulations (CCR). An exit interview was conducted where this Facility Evaluation Report (LIC 809, LIC 809-C), Technical Advisory and Violations (LIC 9102), and Appeal Rights were discussed and copies was provided to Licensee Mercillina Ajunwa.the state’s words, verbatim · CDSS document, Aug 13, 2026

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Resident was not allowed afforded activities or allowed to go outside backyard. Resident sustained cuts while in care. Resident was forced to go to bed. Facility did not have sufficient care staff for residents to be in multiple areas of the facility.

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit for the purpose of delivering findings for the above allegations. LPA met with Administrator Mercillina Ajunwa and explained today's visit. On 04/13/2026, the licensing department received a complaint in regard to facility not offering activities or allowed to go out into backyard, a resident sustained cuts while in care, a resident was forced to go to bed, and facility does not have sufficient staff to care for residents in needs. During investigation, LPA observed facility does offer multiple activities and observed multiple activties to be offered. The investigation consisted of (2) resident interviews. Licensing Program Analyst (LPA) Andrew Martinez attempted to interview Resident #1 (R1), however, R1 does not reside at the facility anymore. LPA Martinez interviewed Resident #2 (R2) who stated activities are provided to residents and facility staff do not restrict residents to go outside. Furthermore, LPA spoke with Administrator in regards to Resident #1 (R1) sustaining cuts while in care. Administrator stated R1 did sustain cuts while in care, however, it was not from or due to facility staff. Unsubstantiated LPA did not corroborate enough evidence that R1 sustaining cuts were due to facility staff. In addition, there was not enough evidence to corroborate that facility staff force residents to go to bed. Additionally, LPA observed facility does not currently retain any residents. Administrator stated facility does have additional staff to work at facility when facility accepts new residents. Based on the evidence gathered during today’s investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Mercillina Ajunwa.the state’s words, verbatim · CDSS document, Aug 11, 2026 · control 56-AS-20260413163430

Type of visit: Required - 1 Year

On 08/11/2025 at 9:39AM, Licensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator Mercillina Ajunwa and introduced self and stated the purpose of the visit. LPA was informed that there are currently no residents in care. The facility has five (5) bedrooms, three (3) bathrooms, kitchen, dining area, living room, office, laundry, attached garage and backyard. LPA completed a walk through of the facility and a review of records Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 77 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 117 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarm, charged fire extinguishers and first aid kit. Postings: Posters such as; the personal rights, emergency disaster plan, CCLD complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed to be kept locked and inaccessible to residents. There is no swimming pool, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, two side gates with self-latching handle on the right side of the house that leads into the backyard. Record Review: LPA reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. Five Technical Violations were given during this visit. An exit interview was conducted where this report LIC809, and LIC809C were discussed and a copy was provided to Administrator, Marciliina Ajunwa.the state’s words, verbatim · CDSS document, Aug 11, 2025

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 07/23/2024 at 09:00 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Mercillina Ajunwa arrived at the facility during the visit. At the time of the visit there were two (2) staff present, and two (two) residents present. The facility is a five (5) bedroom, three (three) bathroom home with a kitchen/dining area, living room/activity room and a garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility’s approved for three (3) hospice waiver. The current census is two (2) residents. LPA Brown was accompanied by Staff #3 (S3) 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). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Brown 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 Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 118 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. However, LPA Brown observed bathroom screen window in disrepair. Technical Violation issued. ***Continuation in LIC809C *** 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. There is a Medicine Room with the resident’s medications locked. LPA Brown observed complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has an Administrator present during the visit. However, LPA Brown observed no night shift staff scheduled to work at the facility as required for facility with dementia residents. Deficiency will be issued. Record Review: LPA Brown reviewed two (2) resident files for admission agreements, updated physician reports, and pre-placement appraisals. LPA Brown observed that Resident #2 (R2) Admission Agreement was not signed by both Licensee/Licensee Representative and Resident/Resident Representative. Deficiency will be issued. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA Brown observed that Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) do not have cardiopulmonary resuscitation (CPR) training and first aid training. Deficiency will be issued. LPA Brown observed Staff #1 (S1) and Staff #2 (S2) do not have the required Health Screening Report in their file. Deficiency will be issued. LPA Brown observed Staff #1 (S1) and Staff #2 (S2) do not have Tuberculosis (TB) Test and TB Test result in their file. Deficiency will be issued. LPA Brown observed Staff #2 (S2) working at the facility but S2's criminal background clearance was not transferred to the facility prior to employment on 08/2022. Deficiency will be issued and Civil Penalties was assessed during the facility visit today with the amount of $500.00 for S2 will continue to be assessed of $100.00 per day per citation until corrected for not transferring S2 criminal record clearance prior to employment to the facility. Furthermore, Medications/Medication Administration Record (MAR) were audited, and LPA Brown observed that Staff #3 (S3) did not update Resident #2 (R2) MAR after dispensing R2's medication. Deficiency will be issued. 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 forms, LIC9102 TA Advisory Notes, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Mercillina Ajunwa.the state’s words, verbatim · CDSS document, Jul 23, 2024

The state marks this report as 21 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

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. Staff do allow resident to wear their own clothes.

Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to investigate and delivering findings for the above complaint allegations. LPA met with Administrator Mercillina Ajunwa and explained the reason for the visit. During today’s visit, LPA interviewed the Administrator and one (1) additional staff. For allegations: 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 resident’s needs, Staff scolded resident, and Staff do allow resident to wear their own clothes: Interviews with the Administrator and an additional staff revealed that the resident involved in the complaint never lived at the facility. The resident lived at another facility that the licensee owns and operates. LPA will investigate the allegations at the correct location. Unfounded Based on evidence obtained during the investigation, the allegations listed above are deemed UNFOUNDED. A finding that the complaints are UNFOUNDED means that the allegations were without a reasonable basis. Therefore, the above allegations are dismissed. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Administrator Mercillina Ajunwa.the state’s words, verbatim · CDSS document, Feb 6, 2024 · control 56-AS-20240202113050

Allegation investigated: Licensee did not provide a 60 day written notice of rate increase to a resident's representative.

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to investigate and deliver findings for the allegation listed above. LPA stated the purpose of the visit and was granted entry and met with Administrator Mercillina Ajunwa. The investigation consisted of resident interviews, staff interviews, and document review. For allegation, Licensee did not provide a 60 day written notice of rate increase to a resident's representative: Interview with the Administrator revealed that Resident R1’s was given a thirty (30) day notice of a rate increase. The rate increase was sent via text message to R1’s responsible party. Document review of R1’s records revealed that the facility did not have a written record of R1’s rate increase. Substantiated For allegation, Facility staff are not meeting resident's hygiene needs: Interviews with the Administrator and the residents revealed that the resident’s hygiene needs are being met by the staff. The staff denied neglecting the resident’s hygiene needs. The facility staff assists with hygiene care such as bathing, grooming, changing clothing, and incontinence care. The residents are bathed based on their individual bathing schedule. The resident’s diapers are checked every two (2) hours by the staff. If a resident needs additional diaper changes, it is done as needed. The residents are groomed when they are showered as well as when needed. The residents clothing is changed daily and or as needed. For allegation, Licensee would not provide a resident’s representative with a copy of the admission agreement: Interviews with the Administrator and R1’s responsible party revealed that R1’s responsible party was given a copy of the admissions agreement. Overall, there was not enough evidence to collaborate the allegations listed above. Based on evidence obtained during the investigation, the three (3) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Mercillina Ajunwa, along with a copy of the appeal rights. Based on evidence obtained during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because of the preponderance of evidence the standard has been met. 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 (LIC9099) and LIC9099D were discussed and provided to Administrator Mercillina Ajunwa, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Oct 25, 2023 · control 18-AS-20210430143456

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Oct 30, 2023

HSC1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents. Based on interview and record review, the licensee did not comply with the section cited above evidenced by not providing the resident with a sixty (60) notice of rate increase which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: The licensee has agreed to read health and safety code 1569.655 entirely and send LPA a self-certified letter that the code was read and understood. The licensee has agreed to provide a sixty (60) day written notice to all residents moving forward when there is a rate increase. POC is due by 10/30/2023.