Moms and Dads

Allegation investigated: Staff not following physician's instructions. Resident developed UTI's and sepsis while in care as a result of neglect Resident was forced to sleep in living room. Staff are not keeping resident's bedding sanitary. Resident's toileting needs not being met while in care. Staff is mishandling a resident's personal funds. Resident's bathing needs not being met.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to investigate the complaint allegations listed above. LPA Haley explained the reason for the visit upon entry. The complaint investigation consisted of interviews and document review. Regarding the allegation: Staff not following physician's instructions. During the investigation, it was not exactly clear if Resident 1 (R1) was diagnosed with scabies or not. According to Staff 1 (S1) and Witness 1 (W1), R1 was not diagnosed with scabies. R1’s roommate was diagnosed with scabies. During an interview with S1, R1 became itchy and S1 reported the itchiness to R1’s home health nurse. S1 says R1’s home health nurse diagnosed R1 with a ringworm and advised the resident to be seen by their physician, and it is alleged that R1’s physician prescribed medication cream for a ring worm. It’s not clear if R1 was ever diagnosed with scabies. Regarding the allegation: Resident developed UTI's and sepsis while in care as a result of neglect. Continued on LIC9099C Unsubstantiated During an interview with S1, it was confirmed that R1 did get sent to the hospital for a UTI. However, S1 says changing the resident was not the problem. According to S1 if R1 was not being changed, R1 would have other complications like redness and bedsores if the resident was not being changed. According to S1, R1 was not drinking enough fluids, and S1 said we could not force the resident to drink more fluids, only offer. Regarding the allegation: Resident was forced to sleep in living room. It is unclear if R1 was ever forced to sleep on in the living room. During an interview with Witness 1 (W1), they stated, the facility moved R1 out of the room with R2 at the request of the R1's family because of R2’s scabies diagnosis. S1 and S2 denied R1 ever slept in the living room. According to S1, R1 was moved into the room of a Resident 3 (R3) who was sent to the hospital and then sent to rehab. According to S1, the facility consulted with the department and the infection control requirements regarding separating the roommates (R1 & R2) and were advised they could move a resident to a vacant room. S1 claims R1 was moved into R3's room because it was vacant while the resident was out of the facility. Regarding the allegation: Staff are not keeping resident's bedding sanitary. During the investigation there was no evidence provided to corroborate the complaint allegation. During interviews there was no information provided about R1’s bed being kept in unsanitary conditions. When S1 and S2 were asked about the allegation, they had no idea what the allegation was about. Regarding the allegation: Resident's toileting needs not being met while in care. During the investigation there was no evidence provided to corroborate the complaint allegation. S1 denied the complaint allegation. S1 claims staff changed R1 or the resident would have gotten bedsores. According to S1, R1 did not have any bedsores or redness on their skin. Regarding the allegation: Staff is mishandling a resident's personal funds. During the investigation there was no evidence provided to corroborate the complaint allegation. S1 and S2 denied the complaint allegation. When both of the staff members (S1 & S2) were asked about the resident stimulus check, neither staff member had a clue what was being referred to. Continued on LIC9099C Page 2 of 3 Regarding the allegation: Resident's bathing needs not being met. During the investigation there was no evidence provided to corroborate the complaint allegation. According to S1, R1 was always clean. S1 says the staff offered a shower every day, and R1 usually agreed to the shower twice a week. However, S1 says the days R1 was not showered, the staff usually gave her a sponge bath and would sit R1 on the toilet and wash the resident’s private areas with soap and water up to help keep them clean. Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report was provided. Page 3 of 3the state’s words, verbatim · CDSS document, Jan 23, 2026 · control 22-AS-20210907083444

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for six resident (5 non-ambulatory), of which one may be bedridden. As of today, the facility has three residents admitted to the facility. All of the residents were present during the visit. There’s a total of 5 bedrooms (4 resident & 1 staff) and 2 bathrooms areas for residents. There’s a living room space, a dining space, backyard and an attached garage. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water was measured at 116.6 degrees F in both restrooms. Kitchen: 5 of 5 burners are operational on the gas stove. Sharps are kept locked in a cabinet under the counter. Cleaning chemicals are stored in a locked cabinet below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Resident & Staff Files: Resident and staff files are stored in the locked filing cabinet in the garage. File Review: 3 of 3 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored in the locked medication cabinet in the kitchen. A first aid kit was also observed mounted on the wall in the dining room. Medication Review: 3 of 3 resident medications were reviewed during the visit. Continued on LIC809C Linens & Hygiene Supplies: Hygiene and incontinent care supplies were observed locked cabinets in the main hallway. Plenty of additional linens were observed in the main hallway cabinets. Garage Area: The garage is organized and walkways are free of obstruction. There’s an office area with a desk and computer for staff. Emergency water was observed and a laundry with a washer and dryer. Soaps and cleaning solutions are in a cabinet above the washer and dryer. Backyard/Exterior: The backyard has a shaded patio area with a table and chairs. A locked storage space was observed on the side of the house. Incontinent care items and a wheelchair was observed. There’s a locked storage shed with a tools. Items no longer being used like bed frames, and an old sink was observed. Administrator was advised to removed the items and email LPA a photo of the backyard. A technical advisory will be issued. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted in the kitchen and in the garage. An emergency drill: An emergency earthquake drill was conducted November 18, 2025. Disaster drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the main postings board at the entrance of the facility. Additional Comments: Licensing fees are current. Facility contact information was reviewed and updated during the visit. Deficiencies observed during the inspection will be cited. An exit interview conducted, and a copy of the report and appeal rights were providedthe state’s words, verbatim · CDSS document, Jan 23, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On January 31, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced, for the purpose of conducting a required one year annual visit using the CARE Inspection Tool. LPA Bentley was greeted, granted entry by staff, and explained the reason for the visit. Administrator (AD) Reca Edora Yap arrived a short time later and was present for the visit. AD Yap has an Administrator Certificate pending approval, received November 25, 2024. Additional administrators/certificates: Ace Edora Tablang expiration date September 26, 2024 and Mc Jevin Tablang expiration date June 21, 2025. Moms and Dads is a one story home with three (3) resident bedrooms, one (1) staff bedroom and two bathrooms. The facility is licensed for six (6) non-ambulatory residents, one (1) bedridden resident, with an approved hospice waiver for three (3) residents. Currently, there are four (4) residents on census of which three (3) are receiving hospice care. All four (4) residents were present during today’s visit. At 9:00AM, LPA Bentley conducted a tour of the physical plant accompanied by AD Yap and the following was observed: All resident bedrooms and bathrooms were inspected. Each bedroom had adequate lighting, furniture, bedding, storage for the residents’ personal belongings, all necessary elements present and rooms were in compliance with regulation guidelines. Additional bed linens, comforters, and bath towels were available during the visit. The kitchen was clean and organized. knives and sharp objects were kept locked in a cabinet below the counter and medications were locked in a cabinet above the counter. A two day supply of perishable food items and seven day supply of nonperishable food items was observed. CONTINUE TO 809-C PAGE In the garage, are two filing cabinets. One cabinet storing resident and staff records. Walkways were free of obstruction. There were three (3) additional refrigerators: two (2) for staff items and one (1) for residents. LPA Bentley also observed a washer and dryer in working condition, several boxes of diapers, and emergency bags for the residents prepared and ready to go. The backyard was clean and free of clutter and debris. The side exit gates were clear and accessible and a shaded patio area with tables and seating observed. There was also a storage shed in the back yard, and additional storage for supplies. There are no bodies of water. A review of four (4) residents (R1-R4) service files and five (5) staff (S1-S5) personnel files revealed to be complete. Two (2) residents and two (2) staff interviews were conducted. A review of the Medication Records Administration (MAR) and medication was conducted, and records were found to be in compliance. The facility has liability insurance effective August 5, 2024 through August 5, 2025. A first aid kit was observed with all the required elements present. There is one (1) fully charged fire extinguisher, observed mounted in the kitchen with a last service date of May 22, 2024. Smoke and carbon monoxides detectors were tested and operational. The last fire and disaster drill was conducted on September 21, 2024, for which a Technical Violation was issued. The facility does not current have a technical device with internet access available for resident only use, and a Technical Violation was given during today's visit. Hot water temperatures in bathrooms were measured and observed at 140.1 degrees Fahrenheit, for which a Type A Violation was given. One (1) deficiency and two (2) Technical Violations were cited during today’s inspection visit. An exit interview conducted and a copy of the report was provided to Administrator Reca Edora Yap.the state’s words, verbatim · CDSS document, Jan 31, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Jerome Haley arrived to complete the required one-year annual visit that was started May 16, 2024. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. During the visit, LPA Haley completed a review of staff records, resident records, reviewed resident medications and completed the inspection tool. As a result of the annual inspection, a Technical Violation was issued for clutter in the backyard. Since the Technical Violation was issued (5.16.24), the clutter and debris have been cleared from the backyard. No further action is needed. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 28, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jerome Haley and conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had the necessary elements and were in compliance with regulation guidelines. Hot water temperatures were measured in the range of 105.6 degrees Fahrenheit and 105.8 degrees Fahrenheit. In the kitchen, knives and sharp objects are kept locked in a cabinet below the counter and the medications are locked in a cabinet above the counter. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. In the dining room are two filing cabinets. One cabinet is used for resident and staff records. A first aid kit was on top of the filing cabinet with staff and resident records. The garage is used to store miscellaneous items. Walkways were free of obstruction. There were three additional refrigerators two for staff items and one for residents. There was a washer and dryer in the garage and soaps and other cleaning supplies are locked in a cabinet. There are several boxes of diapers in the garage and emergency bags for the residents prepared and ready to go. There is a fully charged fire extinguisher mounted on the wall. Administrator Edora Yap will have the fire extinguisher serviced or replaced as the extinguisher expired in March 2023. The backyard has a shaded patio area with a couch and a table and chairs was observed. Both side exit gates are self-closing and self-latching. There’s a shed in the backyard used to store tools. Smoke carbon monoxide detectors tested operational. A disaster drill was conducted March 10, 2024 and are conducted quarterly for all staff. Continued on LIC809C During the inspection, LPA Haley completed the in section of the physical plant, interviewed staff, and residents. Due to time constraints the visit was ended. A continuation visit will be conducted to complete a review of staff and resident records, and a review of all resident medications. At this time there are no citations to be issued upon completion of the visit. A technical violation will be issued as a result of the inspection of the physical plant. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 16, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.