Oani Home Care RCFE

Allegation investigated: Staff did not provide Advance Directives to Medical Personnel Staff did not ensure resident's room was kept free of ants

Licensing Program Analyst (LPA) Rankin conducted a subsequent complaint visit to issue final findings on this investigation. LPA met with Shirley Oani and explained the purpose of the visit. During the investigation, LPA conducted an initial visit on 8/24/26 where LPA conducted an interview with a administrator. During the investigation LPA interviewed current residents, administrator, reporting party, family members, and Home Health Staff. LPA toured all residents’ rooms and the areas outside the rooms on the initial visit. On the allegation: Staff did not provide Advance Directives to Medical Personnel It was alleged the resident arrived at the Emergency Room at or around 2:00 am on 8/20/26 with limited history and without an advanced directive. Per reporting party, the ER staff were told there, “may have been a POLST or advanced directive,” but none was provided at arrival, and the family could not be reached initially to confirm this. Continue on 9099-C Unsubstantiated LPA attempted to contact the reporting party; only one email was received and follow up questions were not answered. Interview via phone call with medical personnel who reviewed notes confirmed the family brought the POLST and residents’ diagnosis to the hospital on the morning of 8/20/26. On 9/14/26 via phone call LPA spoke with family member of resident and was told that they did not believe the facility had the advance directive or POLST, it was something the family needed to provide and that was not done. During the visit on 8/24/26, the outside agency who conducted Home Health support were attending to a resident, LPA interviewed them and was informed that the POLST had been included in the Home Health admission packet provided to the family on 6/18/26. The family was instructed to take it to the primary care provider for completion, but per the agency, the appointment was cancelled. The agency staff was unaware whether the document was ever completed or returned to the facility. A Technical Assistance was issued reminding the facility to document compliance with Title 22, Section 87469 (a), regarding providing information on medical decision making rights, allowing directives in resident files, and ensuring directives are presented during emergencies. Based on the interviews and record review there is not a preponderance of evidence that the facility had a POLST on file and failed to provide advanced directives to the medical personnel therefore the allegation is UNSUBSTANTIATED at this time. On the allegation: Staff did not ensure resident's room was kept free of ants It was alleged that on 8/20/26 resident arrived at the Emergency Room “covered in ants, they were crawling over (their) skin and sheets”. The reporting party did not provide additional details despite follow up attempts made via email on 8/21/26 and 8/25/26. On 8/25/26 LPA contacted the hospital it was confirmed that staff documented the resident arrived “covered in ants.” On 8/25/26 LPA called Emergency Medical Services (EMS) dispatched to the call, EMS could not provide information due to legal restrictions. Continue on 9099-C On 8/24/26 Home Health personnel stated they visit the facility regularly and have never observed ants on any residents. On 8/24/26 LPA conducted a facility tour. No ant activity or trails were observed inside any resident rooms. Two to three ants were observed under an exterior board outside the resident’s exterior door. Two residents were interviewed and denied seeing ants in their rooms, including near food items. All rooms were clean, odor free, and free of debris. On 9/14/26 via phone call, LPA spoke with a family member who stated that the nurse in the ICU mentioned that ants were report to have been on the resident when they were brought in. The family member stated, “I looked at the bedding (the resident) was brought in with, the sheets, and a pillow, and could not find evidence of any ants, not even one.” Family also stated they didn't see ants ever being a problem at the facility. Based on interviews and observations, there is not a preponderance of evidence to prove the facility did not ensure residents room was kept free of ants. Therefore, the allegation is UNSUBSTANTIATED at this time. Report reviewed with administrator and copy left at the facility.the state’s words, verbatim · CDSS document, Sep 15, 2026 · control 29-AS-20260824092344

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:16 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Shirley Oani, administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 4 bedrooms and 2 bathrooms currently occupying 4 residents. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid flooring. The pathways are clear of any obstructions. Disinfectant and cleaning solutions are inaccessible to residents in care. There is sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for resident use with some shade. The fire extinguisher was inspected on 08/7/25. Operational Requirements: The facility has current liability insurance that expires on 1/9/27. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. A hospice waiver is approved for 2 residents. Not approved for bedridden clients. Personnel Records & Training: The facility currently employs 4 full-time caregivers, 2 of which are administrators and back-up caregivers are available. Staff records are kept confidential. Files reviewed for, but not limited to current 1st Aid/CPR, and Health screening with TB results. Administrator’s Certificates expires 5/9/28. Staff have annual training completed for various subjects/topics and hours. Continued 809-C Resident Records & Incident Reports: Resident files are kept confidential. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for but not limited to signed Admission Agreements, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, updated Appraisals Needs and Services will be completed. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides and/or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, and no medications were expired.. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of the report will be emailed to there Administrator.the state’s words, verbatim · CDSS document, Jun 10, 2026

The state marks this report as 7 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

Licensing Program Analyst (LPA) Rankin arrived at 9:35 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Shirley Oani, administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 4 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats and/or flooring. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and additional measures are being implemented. There is sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with some shade. The fire extinguisher was inspected on 8/7/25. Operational Requirements: The facility has current liability insurance that expires on 1/9/26. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. A hospice waiver is approved for 2 residents. Personnel Records & Training: The facility currently employs 4 full-time caregivers, 2 of which are administrators and back-up caregivers are available. Staff records are kept confidential. Files reviewed for, but not limited to current 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions all files complete. Administrator’s Certificates expires 5/9/26. Staff have annual training completed for various subjects/topics and hours for 2025. Continued 809-C Resident Records & Incident Reports: Resident files are kept confidential. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for but not limited to signed Admission Agreements, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all files were complete. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides and/or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducted a quarterly disaster drill 6/20/2025. Emergency exits and telephone numbers were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 14, 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

Licensing Program Analyst (LPA) Miller arrived at 9:30 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Shirley Oani, administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants sprays and cleaners. The facility has a 30-day supply of PPE more available at a separate location. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguisher was last purchased on 8/6/24. The facility has 4 bedrooms and 2 bathrooms currently occupying 5 residents. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors that were tested. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and are locked in a cupboard under the kitchen sink. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with some shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance that expires on 1/9/25. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. A hospice waiver is approved for 2 residents. Staffing: The facility currently employs 4 full time caregivers, 2 of which are administrators and 5 back up caregivers. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator Certificates are currently pending. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023 and 2024. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible, and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill 6/15/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 6, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.