Mom & Dad's House

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Caregiver April and explained the purpose for today’s visit, shortly after Administrators Elsa and Ivonne arrived to assist with the visit. The facility is licensed to serve 6 non-ambulatory residents ages 60 and over with an approved hospice for 4 residents. The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: living room, dining area, kitchen, laundry area, activity/tv room, 5 bedrooms, 2 bathrooms, attached garage. front yard and back yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: Facility maintains the required Infection Control Plan and its reviewed yearly. Operational Requirements: The facility has an approved fire clearance proof of the required liability insurance was provided. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. The hot water temperature was tested and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, hazardous items are kept locked and are inaccessible to residents. Smoke/carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. (Continued on the LIC809-C) Staffing: There appears to be sufficient staffing at all times in the facility. Personnel Records-Training: Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, dementia, hospice and other ongoing training that are electronically documented in personnel files. LPA reviewed 4 staff files with no issues observed. Administrator Ivonne Meader certificate expires on 8/19/2026. Resident Records-Incident Reports: Resident files stored electronically and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information, current Physician's Report. LPA reviewed 5 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters displayed: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a locked cabinet all medication are in their original containers. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The last quarterly fire/emergency drill was conducted on 7/3/25. Residents with Special Health Needs: There facility currently has 1 resident using hospice care, facility maintains proper hospice training and hospice care plan. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was emailed to Ivonne Meader at Meaderiv@mndhouse.comthe state’s words, verbatim · CDSS document, Jul 15, 2025

Allegation investigated: Residents in care have access to hazardous items in the facility. Facility is not equipped with sufficient food items for residents in care. Staff did not ensure the facility was kept free of pest.

Licensing Program Analyst (LPA) Sanjay Vaid conducted a 10-day complaint investigation at the facility and was allowed entry by April Silva Caregiver. April informed the Administrator -Elsa Roman who later joined and discussed the visit. Conducted tour with Elsa and did not observe any health and safety concerns. Licensee Ivonne Meader arrived shortly after and assisted with the complaint. LPA Vaid request obtained and reviewed the following documents: Client roster, staff roster, copy of four (4) weeks of grocery list ordered and four week grocery receipts, pest control product receipts, five (5) residents physicians reports. Five residents’ interviews were attempted, two residents are non-verbal and could not provide information on the complaints, three residents were interviewed. Regarding the allegation: Residents in care have access to hazardous items in the facility. It is alleged that the residents have access to hazardous items and staff is not doing anything to stop this. Four (4) out of four (4) staff interviewed deny this. According to the staff their first duty of the shift is to make visual observations and look for any hazards that may cause residents’ harm. Continued on 9099C............ Unsubstantiated LPA Vaid toured the facility interior and exterior and did not observe any obstructions throughout the pathways of the facility, nor observed hazardous items left out. Staff stated they have residents that wander around the facility and staff are always making sure that residents do not have access to hazardous items. LPA observed all sharps and cleaning products locked and inaccessible to residents. Five (5) out of five (5) residents interviewed could not corroborate this allegation. Residents have not seen any hazardous items at the facility. During LPA’s tour of the facility, did not observe hazardous items at the facility. Based on interviews conducted with facility staff, residents, and observations made the preponderance of evidence standard has been met; therefore, the above-mentioned allegations are found to be unsubstantiated. Regarding the allegation: Facility is not equipped with sufficient food items for residents in care. It is alleged that the facility staff is not providing the residents with enough food for their wellbeing. Four (4) out of four (4) staff interviewed deny this allegation. According to the staff a grocery list is complied throughout the week and order is placed through three vendors and deliveries are made to the facility on Fridays. LPA observed 2-day perishables and 7 day non-perishable, extra food items in the second fridge and water are stored in the garage storage area. Four weeks of grocery list and receipts were provided to LPA. Two (2) out of five (5) residents interviewed could not corroborate this, according to residents interviewed they have access to extra-food can have special meals prepared. LPA Vaid observed lunch served in large portions to residents. Based on interviews conducted with facility staff, residents, observations made, and records reviewed. 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. Regarding the allegation: Staff did not ensure the facility was kept free of pest. It is alleged that the staff is not keeping pests (cockroaches and rodents) from infesting the facility. Four (4) out of four (4) staff interviewed deny this allegation, they have never had pest problems at the facility. According to Licensee Ivonne Meader, the facility was proactive in calling pest control company after the staff reported seen dropping on 5/5/25 and called the pest control company on 5/6/25, that advised the facility with placing contained high-voltage shock rodent traps around the facility. Pest control technician contacted on 05/06/24 concluded based on the information received of droppings found in only three places of the facility and through pest control technicians experience that the facility did not have a pest problem. The licensee will call pest control company if pest/droppings are observed in the facility. The pet therapist had visited the facility on 5/5/25 with four service animals for the residents, all animals were accounted for after the visit. The pet therapist uses blanket for the animals in case the animals defecate. The pet therapist confirms they check the area for dropping from the service animals before leaving the facility. Continued on 9099C................. The droppings were concluded to be of the service pets. There have been no reported sightings of pest or droppings after the pet therapists visit on 5/5/25, according to staff interviewed. Five (5) out of five (5) residents interviewed could not corroborate this allegation. LPA Vaid checked under the kitchen and bathrooms cabinets with a flashlight and did not observe any presence of pests or dropping in the kitchen or bathrooms cabinets. Based on interviews conducted with facility staff, residents, observations made. 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. Exit interview was conducted and copy of this report was provided to Licensee Ivonne Meader.the state’s words, verbatim · CDSS document, May 20, 2025 · control 28-AS-20250513133628

Allegation investigated: Staff handled resident in a rough manner.

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial 10-day visit to investigate the above allegation. LPA met with Editha Padua/Caregiver and April SIlva/Cargiver and explained the purpose of the visit. Administrator Ivonne Meader is out of town but LPA spoke to her on the phone at 10:50am and explained the reason for the visit. At 12noon, Jose Umana, acting Administrator arrived and assisted LPA with the investigation. The investigation cosisted of the following: LPA Pena obtained copies of the staff & resident rosters, Staff In service training certificates (Recognizing and Reporting Abuse, Resident's Rights, Dementia related Behaviors), Resident #1 (R1) files such as: Identification and Emergency Information, Resident Appraisal, Admission Agreement, Physician's report, Hospital Discharge record, Medication Record (Oct 2024) and Unusual Incident/Injury Report (12/16/2024). LPA interviewed Staff #1 (S1) telephonically, Staff #2 (S2) - Staff #3 (S3) in person and Resident #2 (R2) - Resident #3 (R3). LPA attempted to interview Resident #4 (R4) - Resident #6 (R6), but unsuccessful due to their cognitive abilities. Resident #1 (R1) is out in a specialized hospital; therefore not interviewed. ******CONTINUED ON LIC 9099C***** Unsubstantiated The investigation revealed the following: In regards to the allegation: "Staff handled resident in a rough manner." It is alleged that a staff pushed and shoved R1 on a daily basis. Specific details of the alleged incident were not provided. Interview conducted with (3) of (3) staff members all denied the allegation. Staff members interviewed indicated that they have never pushed nor shoved any resident nor have they observed any other staff member push/shove any of the residents. Staff interviewed also stated that they treat all residents with respect and they received zero tolerance policy, elderly abuse and mandated reporting training yearly. S1 stated that R1 was admitted to a specialized hospital approx. 2 months ago due to exhibiting behaviors of mental health concern such as confusion, anxiousness, medication refusal and food refusal. (2) out of (5) residents interviewed also denied the allegation. Interviewed residents indicated that facility staff treat them with dignity and they feel safe at the facility. Residents interviewed also indicated they have never observed staff members push or shove any of the residents. Therefore there was insufficient evidence to corroborate with the allegation. Based on statements and interviews conducted with residents and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation. 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. Exit interview and a copy of this report was provided to the Acting Administrator, Jose Umana.the state’s words, verbatim · CDSS document, Jan 21, 2025 · control 28-AS-20250113161518

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Case Management Deficiencies in conjunction with a complaint visit (Complaint Control # 28-AS-20250113161518). The purpose of this visit is to issue deficiency that was observed by LPA that is not part of the complaint allegation. During the visit on 01/21/2025, LPA spoke with the Administrator, Ivonne Meader on the phone and stated that she is out of town. Administrator confirmed that she did not inform CCL of her temporary absence nor submitted a designation of facility responsibility form to CCL. However, Administrator stated that she has designated, Jose Umana as Administrator (Tel: 818-606-6136) in her absence and will fax CCL the designation of facility responsibility (LIC308) immediately. Deficiency is noted on LIC 809D. Exit interview, a copy of this report and Appeals Rights were provided to Jose Umana, Acting Administrator.the state’s words, verbatim · CDSS document, Jan 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.618(a) · Plan of correction due date: Jan 24, 2025

1569.618 ...Administration and management of residential care facilities; ..(a) The administrator designated by the licensee pursuant to paragraph...shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. This requirement is not met as evidenced by: Administrator is out of town and did not submit Designation of Facility Responsibility to CCL to notify who the contact/Administrator responsible for the facility in her absence which poses/posed a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: The Administrator shall ensure to assign an acting Administrator to be responsible for the operation of the facility when the administrator is temporarily absent from the facility. Administrator agreed to fax the Designation of facility responsibility (LIC308) to CCL/LPA by POC due date.OC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tyler Reyes conducted an unannounced annual visit at the facility using the CARE Tool. LPA Reyes met with Ivonne Meader (Administrator) and explained the reason for the visit. The facility is licensed to serve six non-ambulatory residents ages 60 years and above and approved for four hospice waivers. Facility is operating within the scope of it's license. A tour of the single-story facility included: living room, family room, kitchen, dining area, 5 resident bedrooms, 2 bathrooms, front yard, backyard and attached garage. LPA and Ivonne toured the facility and the following was observed: Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 113.3 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen in each resident bedroom’s closet and clean towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There are carbon monoxides in the hallway and are properly operating. There is a fire extinguisher in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps, cleaning supplies and toxins are kept locked in a kitchen cabinet and are inaccessible to residents. First Aid kit was fully stocked with current manual and it is kept in the medication cabinet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. The facility has a video camera monitor system in all common areas and hallway. All residents signed the video camera monitor system plan of operation and there are signs stating "security cameras in use". Residents medication are centrally stored in a locked cabinet in the dining area. Residents and staff files are centrally stored in the garage. LPA reviewed medication for all 6 of the residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 6 residents and 6 staff. LPA interviewed 2 residents and 2 staff. LPA observed administrator certificate for Ivonne Meader – 6032304740 with an expiration date of 08/19/2024. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report were provided.the state’s words, verbatim · CDSS document, Jul 5, 2024

Type of visit: Office

On 03/27/24, an informal meeting was held at the Monterey Park Adult and Senior Care Regional Office. The purpose of this office meeting was to discuss deficiencies issued at the facility – Mom & Dad’s House - 198601959. Present in today’s meeting: Licensing Program Manager – Adeline Ho, Licensing Program Manager – Lisa Hicks, Licensing Program Analyst – Luis Mora, Licensing Program Analyst – Angelica Rea, Licensee – Matthew Meader and Licensee – Ivonne Meader. During the meeting, the following were addressed: Complaint investigation findings for complaint control number 28-AS-20210415130140 and 28-AS-20210621085853. Pre-admission fee of $2500 was added to the admission agreement without notifying CCLD. Created a waiver of liability and hold harmless agreement for a resident without notifying CCLD. Importance of following the plan of operation and notifying CCLD of any changes. Importance of seeking CCLD's advice prior to implementation. The following Title 22 topics were discussed and copy of the section were given during the office meeting: Plan of Operation 87208. CCLD mission statement. An exit interview was conducted and a copy of this licensing report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2024