Sakura Gardens Villa

Type of visit: Required - 1 Year

On 01/28/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced annual inspection. LPA met with Administrator, Beverly Carnate. LPA explained the purpose of the visit. The facility was under partial renovation at the time of visit. LPA toured the facility to include the hallways, resident bedrooms, bathrooms, recreation room, dining room, kitchen, and exterior. All staff present are fingerprint cleared and associated to the facility. LPA observed all residents in the dinning room watching TV and exercise. Backyard was fenced, secured, and in good condition. All outdoor and indoor passageway were free and clear of obstruction. No accessible bodies of water or fire safety hazards observed. Kitchen was inspected, sufficient supply of food observed. Infection control practices reviewed. Medications, toxins and sharps stored appropriately and inaccessible to clients, a comfortable temperature was maintained, hot water temperature inspected to be compliant, furnishing and lighting was sufficient for comfort and safety. Carbon monoxide detector and smoke detector system inspected and met the requirements. fire extinguisher checked and fully charged. Facility has a written emergency disaster plan. Licensee has at least one completed first aid kit located in the office. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. No deficiencies were cited. Technical violation was noted for work order to fix one out of two water heaters. The report was reviewed and discussed with administrator. A copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Jan 28, 2026

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.

Type of visit: POC

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced at 3:55PM and met with Staff Beverly Carnate. The purpose of this visit is to follow up on a deficiency issued during a Required 1 year inspection on 1/21/2025. LPA explained the purpose of the visit to Licensee. On 1/21/2025, LPA Tarin conducted the facility's required 1 year inspection. During inspection, LPA observed a damaged and discolored kitchen counter top next to the sink, spider webs in the ceiling of the bathrooms, and dark spots on the shower floor (next to bedroom #8). A deficiency was issued and the Plan of Correction (POC) was developed with the Licensee. The Licensee states the facility would submit a date when the kitchen counter top would be repaired and the dark spots and spider webs would be cleaned. The Licensee submitted POC to LPA by POC due date of 1/22/2025. During today's visit, LPA inspected the kitchen counter top, the bathroom and interior of facility. LPA observed that the kitchen counter top was repaired, no spider webs were observed and dark spots in the bathroom had been removed (re-grouted). LPA Tarin cleared the deficiencies cited on 1/21/2025 during today's visit. A Letter of Deficiency Citations Cleared was printed and provided to Staff during today's visit. No deficiencies were cited during today's visit. A copy of this report was provided to Staff Beverly Carnate.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct the facility's Required 1-Year annual inspection. LPA met with Staff Tomoko Yoshida. LPA toured the facility to include the hallways, resident bedrooms, bathrooms, recreation room, dining room, kitchen, and exterior. All staff present are fingerprint cleared and associated to the facility. LPA observed 5 residents in the recreation room watching tv and reading the newspaper. LPA observed the hallway temperature display at 71 degrees Fahrenheit. LPA observed 2 hallway exit routes are lit with sunlight from the windows above the hallway. LPA observed posters for complaint reporting, ombudsman, and Resident's Rights. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature maintained at 40 degrees F and freezer maintained at 0 degrees F. At 10:16AM LPA observed a damaged and discolored kitchen countertop area where food is prepared, next to the kitchen sink. LPA advised staff to repair counter top and to ensure the facility is in good repair. LPA toured 15 resident bedrooms. 14 out of 14 resident bedrooms had a bed, functioning lights, a dresser/table, a chair and space for personal belongings. 1 resident bedroom is being used as storage. LPA advised staff to update the facility sketch and submit to the Department by 1/31/2025. LPA measured water temperature for 6 resident bathrooms at 105 degrees F. LPA observed spider webs in the ceiling of the bathrooms, and dark spots on the shower floor (next to bedroom #8). LPA advised staff to ensure the facility is in good repair at all times. See LIC809-C LPA reviewed 3 staff records. 3 out of 3 staff records were complete and included background fingerprint clearance, health screening with TB result, staff training and first aid certification. LPA reviewed 4 resident records. 4 out of 4 resident records were complete and included emergency contact information, medical assessments, and needs and service plans. LPA also reviewed 4 Centrally Stored Medication and Destruction Records (CSDMRs). 4 out of 4 CSMDRs were observed to be complete with all medication documented accurately. LPA reviewed emergency drill logs. LPA observed the facility conducts their emergency drills quarterly. The last drill was completed on 1/16/2025. The facility's last fire inspection was conducted on 3/28/2024. The facility's fire extinguisher was last serviced on 09/05/2024. Facility has smoke alarms and carbon monoxide detectors present throughout the hallways. LPA requested the facility submit an updated facility sketch to the Department by 1/31/2025. A deficiency was cited today per California Code of Regulations, Title 22. See LIC809D. This report was reviewed with Staff Tomoko Yoshida and copy of this signed report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 21, 2025

Allegation investigated: Facility did not ensure resident safety, resulting in resident sustaining an injury

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Administrator, Beverly Canate and stated the purpose of today’s visit. On 9/7/2023, the Department received a complaint with the above allegation. On 9/14/2023, the Department conducted an initial investigation at the facility. It was alleged resident (R1) sustained injury which was a result of staff neglecting R1 on 9/5/2023. On, 9/5/2023, the facility staff submitted an Incident Report for incident occurring on the same day for R1 who lost consciousness. Per report, staff were present and observed R1 losing consciousness and called 911 and informed R1’s responsible party. Continuation on LIC 9099, Page 1 of 2. Unfounded Page 2 of 2. On 9/14/2023, the Department interviewed 6 facility staff (S1-S6). All six staff stated on 9/5/2023, the resident lost consciousness during lunch time and staff were present in dining room and observed R1 and called 911 right away. Six out of six staff stated R1 was combative and sustained injuries when exhibited combative behavior. Six of six staff stated they have not seen or heard staff hurting or physically abusing R1 or other residents. Six out of six staff stated they have seen resident hurting or physically abusing R1 or other residents. Three of out the six staff provide direct care and supervision to R1. All three staff stated R1 has had combative behaviors where R1 will hurt themselves by hitting the side rails or the walls when R1 is agitated. On 9/14/2023, the Department was not able to interview residents at the facility due residents not responding or refusing to answer LPA’s questions related to the investigation. Based on review of R1’s documents, R1 has a neurocognitive disorder and history of skin bruising to due agitation. Based on review of R1’s Physician’s Report dated 5/17/2023, R1 is diagnosed with neurocognitive disorder and was diagnosed with nontraumatic subdural hematoma. Based on review of Incident Reports from 8/22/2023 – 9/5/2023, facility staff observed self-inflicted bruising due to R1 falling from bed. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator, Beverly Canate and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 21, 2024 · control 26-AS-20230907105608

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required - 1 year inspection. LPA met with Administrator, Hiro Kitamura. During visit, LPA toured the facility to include the hallways, resident bedrooms, bathrooms, activity room, dining room, kitchen, and exterior. All staff present are fingerprint cleared and associated to the facility. LPA observed some exit routes were obstructed with a dresser, table with wheels, and a walker. Staff immediately moved the items to ensure the exit routes are free and clear of obstruction. Administrator was advised. Posters observed to include the complaint poster, ombudsman, and rights of resident council. Facility temperature maintained at 72 degrees Fahrenheit. The facility's fire extinguisher last serviced on 09/05/2023. Facility has smoke alarms and carbon monoxide detectors present throughout the hallways. The facility's hallways are lit up by natural light from the outside. Due to the overcast today, LPA observed the facility hallways where resident bedrooms are located were slightly dark. LPA obtained a photograph. Administrator states, during the night the hallways are lit up by 1 light at the end of each hall. LPA advised to install additional lighting in the hallways to ensure the residents safety and comfort during the night. Administrator stated understanding. Administrator also states during the night, they do not have any residents who wander and the residents are assisted with toileting. LPA observed the activity room, dining room, bathrooms, and resident bedrooms contained adequate lighting. Kitchen supplied with cups, plates, bowls, and utensils. The refrigerator temperatures maintained between 28 - 35 degrees Fahrenheit. The freezer temperatures maintained below 0 degrees Fahrenheit. Food items were observed covered and labeled. Facility has at least 2 days worth of perishables and 7 days with of non-perishable foods. SEE LIC809-C. Resident bedrooms were well maintained and free of clutter and odor. The bedrooms contained adequate lighting, bed, linens, chair, and dresser. LPA observed 2 resident beds contained half rails. LPA observed 2 out of 2 residents files contained an order for half rails. Bathrooms supplied with hygiene products, paper supplies, and non-slid mats in the shower. The bathroom next to room #8 hot water temperature maintained at 108 degreed Fahrenheit. The bathroom next to room #3 hot water temperature maintained at 138 degrees Fahrenheit. Administrator was advised. Facility has emergency back-up lighting throughout the hallways. Facility's emergency disaster plan was last updated in 2019. Administrator was advised to update their emergency disaster plan. LPA observed the facility conducts their emergency drills quarterly. The last drill was completed on December 2023. Facility has an infection control plan and sufficient amount of PPE supplies. LPA reviewed 5 resident files. The resident files were observed complete, however, did not contain an appraisal/needs and services plan. Administrator states to be in the process of updating each resident's appraisal/needs and services plan and brought the records to another location. Administrator was advised to ensure the original copies are always in the facility during normal business hours. Administrator stated understanding. 5 out of 5 residents centrally stored medications and records observed maintained. LPA reviewed 4 staff files. Staff files were completed to include an updated 1st aid certification, fingerprint clearance, health screening, and TB result. Staff are provided at least 20 hours of annual training to include but not limited to dementia, postural supports, medications, restricted health conditions, and hospice. 5 residents and 3 staff were interviewed. A deficiency is being cited per California Code of Regulations, Title 22. See LIC809-D. Advisory notes provided. This report was reviewed with Administrator, Hiro Kitamura and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Jan 31, 2024