Omnicare III

Allegation investigated: Staff do not ensure a comfortable temperature for residents is maintained Staff do not treat resident with dignity

Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced subsequent complaint visit to this facility today to deliver investigation finding. LPA met with staff and introduced self. Staff contacted Laila Kulungu, Assistant Administrator and reason for the visit was explained. Investigation finding was discussed and staff was designated to sign the report. On 03/10/2026, the Department received the above listed allegations. On 03/18/2026, LPA Chochian conducted complaint visit. Beginning at approximately 12:15PM, LPA and staff toured the facility common areas and resident rooms. Facility temperature observed at 72 degrees Fahrenheit (F) and outside temperature was approximately 93 degrees F. At approximately 12:45PM LPA reviewed facility records including but not limited to resident files. Between 1:15PM-2:45PM, LPA interviewed the Administrator, staff, and other potential witnesses. LPA attempted to interview residents. All residents currently have cognitive issues however two (2) out of the four residents were able to converse with LPA and expressed being happy with the facility and staff. No issues were reported about the facility being cold. (Continue to LIC9099c) Unsubstantiated Following is a summary of the allegations and finding: Regarding allegation “Staff do not ensure a comfortable temperature for residents is maintained”. Information was received that resident #1 was observed to be cold, and staff did not ensure resident was appropriately covered. During the initial visit LPA attempted to interview resident #1 however resident was unable to answer questions. Other residents and families were interviewed during the initial visit and reported no issues and shared that they are very satisfied with the care staff. No issues were reported about the facility temperature. Facility temperature was observed to be 72 degrees during the visit on 03/18/2026. Staff reported that resident #1 is often cold especially after showers, therefore staff provide a blanket for resident #1 when in the common area. Staff reported that each resident has a blanket and the facility also has extra blankets. LPA observed sufficient supply of blankets at the facility for residents use. LPA attempted to reach the reporting party on 3/18/2026, 4/23/2026 and 5/12/2026. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Staff do not ensure a comfortable temperature for residents is maintained” is deemed unsubstantiated at this time. Regarding allegation “Staff do not treat resident with dignity”. Information was received that staff said “don’t pay attention to what residents say because they have dementia”. Staff interviewed denied the allegation and reported that residents are all treated with dignity and respect. Staff explained that resident do have cognitive issues and repeat things and staff do acknowledge that and redirect and ensure residents health and safety is not compromised in any way. Interview was attempted with all residents. Two out of the four residents were able to communicate and shared no concerns about the treatment of staff. Both residents interviewed reported that they are pleased with the staff at the facility and are treated well. Residents’ responsible persons interviewed expressed being very satisfied with the care and staff. No issues were reported. LPA attempted to reach the reporting party on 3/18/2026, 4/23/2026 and 5/12/2026. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Staff do not treat resident with dignity” is deemed unsubstantiated at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, May 17, 2026 · control 29-AS-20260310103157

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual inspection. Upon arrival LPA was greeted by staff and entrance interview and introductions conducted. Assistant Administrator Laila Kulungu was contacted and arrived to the facility. At approximately 110:15a.m., LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher located in the kitchen was observed fully charge with receipt dated 10/2025. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted in the main hallway area wall. Other required postings are also posted on the main hallway area wall. KITCHEN: Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans, and drink ware is adequate. The supply of nonperishable food is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, and house cleaning supplies are stored and locked under the sink cabinet area. BEDROOMS: The facility has six (6) private residents’ bedrooms, and one (1) staff’ bedroom. All bedrooms observed with required furniture and clean linen. Lighting in the rooms appeared sufficient. BATHROOMS: There are three (3) bathrooms. Hot water temperature was tested in all restrooms and recorded between 109-118 degrees Fahrenheit. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. Entertainment equipment, books and/or activity supplies observed for residents use. There was sufficient space to accommodate both indoor and outdoor activities. Alarms on all exterior doors were engaged at the time of visit and functional. Garage was observed locked and contained extra food, PPE supplies, cleaning supplies, and water supply. Laundry room observed with supplies and chemicals locked in the cabinets. LPA reviewed the facility emergency disaster and infection control plan with Ms. Kulungu. (Continue to LIC809c) INFECTION CONTROL: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly as is required. Earthquake and fire drill conducted on 10/1/2025. Smoke/carbon monoxide detectors were tested at 11:15am and observed operable. OUTDOOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio with furniture for residents use. LPA met with all five residents, one family member and two staff. Resident #1 was observed seat belted in a wheelchair. Interview with staff revealed that the family installed the seat belt to prevent resident #1 from falling forward. LPA informed staff that postural devises cannot be used to restrain resident, cannot be used to prevent falls; can only be used to assist in mobility. RECORD REVIEW: Records review began at 11:30a.m.-1p.m.. LPA observed all five (5) resident records for documents including, but not limited to: needs and service appraisals, medical records, admissions agreement, and consent forms. LPA observed three (3) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and required training. Resident and Personnel files reviewed were in order and had no missing documents. MEDICATIONS: Medications are stored inaccessible in locked cabinets in the hallway/office area. Beginning at 1:30p.m.-2:30p.m., LPA reviewed five (5) residents medication and medication records. Medications were observed to be properly documented on the centrally stored medications. One out five residents medications reviewed did not have a prescription for over the counter medication (advil/cough syrup). Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual inspection. Upon arrival LPA was greeted by staff and entrance interview and introductions conducted. Administrator Laila Kulungu was contacted and arrived to the facility. The LPA and administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans, and drink ware is adequate. The temperatures for the refrigerator and freezer could not be verified as neither have a thermometer. The supply of nonperishable food is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, and house cleaning supplies are stored and locked under the sink cabinet area. BEDROOMS: The facility has six (6) private residents’ bedrooms, and one (1) staff’ bedroom. All bedrooms observed with required furniture and clean linen. Lighting in the rooms appeared insufficient - lamps used in residents bedrooms did not provide sufficient lighting. BATHROOMS: There are three (3) bathrooms. One is a private bathroom located in bedroom #1. Two (2) bathrooms are located in the hallways and are for residents' and staff use. Hot water temperature was tested in all restrooms and recorded between 114-117 degrees fahrenheit. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. Entertainment equipment, books and/or activity supplies observed for residents use. There was sufficient space to accommodate both indoor and outdoor activities. There is a fireplace in the living room observed with cover. Alarms on all exterior doors were engaged at the time of visit and functional. Garage was observed locked and contained extra food, PPE supplies, cleaning supplies, and water supply. Laundry room observed with supplies and chemicals locked in the cabinets. Medications observed locked in the cabinet in the hallway; each resident medications stored in separate boxes. The exterior passageways were clean and clear of any obstructions. There is a covered patio with furniture for residents use. Interviews conducted with two staff and three residents. Due to time technical difficulties and time constraints annual inspection will continue on another date for records review. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Name - Oyewole Joseph Jose CEO/ Verona Isambi Administrator Interview Method: Telephone interview On December 13, 2023, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Dec 13, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a pre-licensing visit to the above noted facility. The LPA met with Administrator, Laila Kulungu. This is an application for a Change of Ownership (CHOW). The facility applied for five (5) non-ambulatory residents, and one (1) bedridden resident. At 10:40 a.m., the LPA and the facility designee conducted a physical plant tour inside and out to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The facility is a one story dwelling. An approved fire clearance was received on 10/23/2023, clearing them for five (5) non-ambulatory residents; one (1) bedridden resident in bedroom #2. KITCHEN: Kitchen knives are stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans, and drink ware is adequate. The temperatures for the refrigerator and freezer could not be verified as neither have a thermometer. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, and house cleaning supplies are stored and locked under the sink cabinet area. No flies or other vermin were observed. Water temperature was recorded at 112.3 degrees Fahrenheit. BEDROOMS: The facility has six (6) private residents’ bedrooms, and one (1) staff’s bedroom, total of seven(7) bedrooms. Bedroom # 2 has been approved and cleared for one bedridden resident. All bedrooms were set up with night stands, lamps, and closet space. The screen sliding door in bedroom#2 became jammed when trying to slide it open. Continues on LIC 809C... Page 2. All beds were furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. All rooms were free of odors. All window screens were clean and maintained in good repair. BATHROOMS: There are three (3) bathrooms. One is a private bathroom located in bedroom #1. Two (2) bathrooms are located in the hallways and are for residents' and staff use. Hot water temperature was tested in all restrooms and recorded between 110.3- and 116.5-degrees Fahrenheit. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, books and/or activity supplies in the family room. There was sufficient space to accommodate both indoor and outdoor activities. There is a fireplace in the living room, which is missing a fireplace cover. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility recorded a comfortable temperature of 73 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detectors were tested and functioned properly during the time of visit. There is one (1) fire extinguisher mounted on the wall. The extinguisher was last serviced on 08/03/2023. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted on the wall by bedroom #6, as well as other required postings. Resident and staff records are stored in a filing cabinet, which is currently located in the office area. Continues on Page 3... Page 3. Medications are centrally stored in a locked top cabinet located in the office area. The first aid kit was available but is missing the manual. The laundry room is located in the hallway adjacent to the family room. Laundry supplies and chemicals are stored in locked cabinets, inaccessible to residents in care. Garage was observed locked and contained extra food, PPE supplies, cleaning supplies, and emergency food and water supply. OUTDOOR/GARAGE AREA: The exterior passageways were clean and clear of any obstructions. There is a covered patio and patio furniture. Three recliners ready to be disposed of, need to be removed from patio area. The entire property is fenced. The back and sides of the house are separated from the front yard by gates at the north and south side passageways. The following deficiencies were observed during the inspection and the applicant agree to have them resolved by Monday, November 6, 2023. 1. Bedrooms: The screened sliding door in bedroom#2 became jammed when trying to slide it open. 2. Living Room: The fireplace in the living room, is missing a fireplace cover. 3. Kitchen: Refrigerator and freezer need a thermometer. 4. Outdoor: Three recliners ready to be disposed of, need to be removed from patio area. 5. Miscellaneous: First Aid kit is missing the first aid manual. 6. Seven (7) day supply of food and water need expiration dates. At 1:25 p.m., the applicant/Administrator completed Component III Orientation. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview was conducted and reviewed with Administrator Laila Kulungu. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 1, 2023