Seiko's Place

Type of visit: Required - 1 Year

On 07/29/2026 at 11:15AM, Licensing Program Analyst (LPA) Andrew Christy arrived unannounced to conduct the 1-Year Annual Required inspection. LPA met with Administrator, Matt Ofahengaue, and explained the purpose of the visit. The facility currently houses five (5) residents with a max capacity of six (6) residents. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area, and backyard. All outdoor and indoor passageways are kept free of obstruction. No bodies of water were observed. A comfortable indoor temperature is maintained at 69.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 115.6 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/29/2026. At 12:30PM, LPA reviewed five (5) resident files and three (3) staff files, all found to be complete. The emergency disaster plan was last reviewed 07/29/2026. Quarterly emergency drills were last conducted 06/03/2026. A review of resident medications and the Medication Administration Record (MAR) found no outstanding errors. No deficiencies cited during visit. Exit interview conducted and a copy of this report was provided to the administrator.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Required - 1 Year

On 07/03/24 at 12:45 PM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Mateaki 'Mat' Ofenhengaue, House Manager and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with caregiver including but not limited to bedrooms, bathroom, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all 5 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 114.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 5/22/25. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 05/05/2025. LPA reviewed 4 resident and 2 staff files and all were complete. LPA also reviewed a sample of 4 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 7/17/25: LIC 610D Emergency Disaster Plan Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 3, 2025

Allegation investigated: Staff left the residents unattended.

On this day, June 5, 2025, at 2:20 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to deliver the findings for the above allegation. LPA met with Gladys Corpuz, staff. LPA called and spoke over the phone with House Manager (HM) Mateaki 'Mat' Ofenhengaue who stated he can not come to the facility and gave permission to Gladys Corpuz to sign and receive this report. During the course of investigation, LPA conducted interviews. LPA reviewed residents' files and obtained copies of the following residents' documents: LIC602A Physician's Reports; hospital After Visit Summary. LPA also obtained copies of LIC9020 Register of Facility Clients/Residents, staff schedule and contact information. LPA interviewed the following: reporting party (RP) on 5/16/25; staff (HM) on 5/22/25; staff (S3) on 5/28/25. .....continued on 9099C (page 2) Substantiated Page 2 It was alleged that when resident’s (R1) family member went to the facility on 5/01/25, the staff was in the shower, and it was resident (R2) who opened the door. HM stated that R1's wife (FM1) was at the facility on 5/01/25 at around 6:30 pm, then left and came back. HM further stated that S3 was in the shower at the time when FM1 came back, and it was R2 who opened the door. S3 confirmed she was by herself and was taking shower and it was R2 who opened the door for FM1. Review of records showed R2 has major neuro cognitive disease and has wandering behavior. Based on interviews and records review, the preponderance standard has been met, therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date along with the LIC9098 Proof of Correction form and any repeat violation within 12 month period may result in civil penalty Deficiency and plan and proof of correction were discussed with HM over the phone. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. Page 2 Allegation: Staff are not providing adequate care and supervision of a resident (R1). It was reported that R1 had fallen out of bed and when FM1 came to the facility on 5/01/25, FM1 found R1 in poor condition and FM1 called 9-11. S1 and S3 stated they were not in the facility when FM1 called 9-11 and R1 was sent out. S1 stated R1 came back the following day. HM stated he talked to FM1 and asked why she wants to call 9-11 and FM1 said R1 does not look good. HM further stated the ambulance came, checked and took R1 vitals and didn't see anything but FM1 insisted to have R1 sent out. FM1 stated she does not have complaint about the care R1 is getting from the facility and that R1 did not fall out of bed. LPA interviewed and verified with RP who stated R1 was diagnosed with weakness and was discharged back to the facility the following. Review of hospital After Visit Summary dated 5/02/25 indicated the following: no admission diagnosis during encounter; no admission procedures for hospital encounters; no comments available. R1 was not able to provide information regarding the incident. Therefore, the allegation is unsubstantiated. Allegation: Staff mishandled a resident. It was alleged that when R1 asked staff to speak English, the staff lifted R1 up by R1’s shirt and put R1 back to bed and that R1 appeared upset. S1 stated that he was getting/preparing and giving R1 morning care when the incident happened. R1 was out balanced and about to fall and his immediate reflex was to catch R1, so he hold R1 onto his shirt to prevent him from falling. S1 denied handling any residents roughly. S1 and S3 also denied handling any residents roughly and stated not observing S1 handled the residents roughly. Three out of 5 residents stated all the staff are nice and never handled them roughly. Due to medical diagnosis, LPA was unable to obtain information from the other 2 residents on how they are handled and/or assisted by the staff. Therefore, the allegation in unsubstantiated. .....continued on 9099C (page 3) Page 3 A finding that a complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Jun 5, 2025 · control 15-AS-20250514132244

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jun 6, 2025

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs……............... -This requirement is not met as evidenced by: -Based on record review and interviews, the licensee did not comply with the section above when staff left the residents unattended which posed an immediate safety and/or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Jun 5, 2025

Plan of correction: Administrator to in-service the staff and submit copy of training topic with attendees signatures by 6/06/25.

Type of visit: POC

While at the facility for a complaint (Complaint Control # 15-AS-20250514132244), Licensing Program Analyst (LPA) Delmundo conducted a Proof of Correction visit for the deficiencies/citations issued by LPA on 5/22/25. LPA met with Gladys Corpuz, staff. LPA called and spoke over the phone with House Manager (HM) Mateaki 'Mat' Ofenhengaue, and informed the reason for visit. On 5/22/25, LPA conducted a case management visit and issued type B citations for the following deficiencies with proof of corrections (POCs) to be submitted by 6/05/25: 1. Deficiency section # 87211(a)(1)(D) 2. Deficiency section # 87458(a) LPA only received the POC (copy of LIC602A Physician's Report) for deficiency section # 87458(a) on 6/04/25. The POC for deficiency section # 87211(a)(1)(D) is not received. LPA discussed the above over the phone with HM and informed that POC for # 87211(a)(1)(D) shall be submitted by end of the day today. HM stated he will submit today. HM also stated he can not come to the facility and gave permission to Gladys Corpuz to sign and receive this report. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Case Management - Deficiencies

While at the facility investigating a complaint (Control # 15-AS-20250514132244) and upon review of residents' records and interviews, Licensing Program Analyst (LPA) Delmundo observed the following: 1. Facility did not submit Unusual Incident Report for resident (R1) when R1 was sent out to the hospital on May 1, 2025. 2. The other resident's (R2) LIC602A Physician's Report on file was dated November 2021 and missing pages #'s 3 and 4. R2 was admitted to the facility on November 2021 and updated LIC602A was never obtained. The above were discussed with House Manager (HM) Mateaki 'Mat' Ofenhengaue. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with HM. HM has to leave and gave permission to Gladys Corpuz, staff, to sign and receive this report. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, May 22, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jun 5, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days (D) Any incident which threatens the welfare, safety or health of any resident... -This requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above in not submitting an incident report wheh R1 was sent out which posed a personal rights risk to person in care,the state’s words, verbatim · CDSS document, May 22, 2025

Plan of correction: Administrator to do the followiing and submit POC by 6/05/25: 1. Complete and submit the incident report. 2. Read the Regulations and submit self-certification that report will be submitted timely.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Jun 5, 2025

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice..... -This requirement is not met as evidenced by: -Based on record review and interview, the licensee did not comply with the section above in not obtaining a complete LIC602A nor having a current/updated LIC602Athe state’s words, verbatim · CDSS document, May 22, 2025

Plan of correction: Administrator to schedule a medical assessment and submit copy of the LIC602A by 6/05/25.

Type of visit: Required - 1 Year

On 07/12/2024 at 1:50 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Caregiver, Gladys Corpuz and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with caregiver including but not limited to bedrooms, bathroom, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all 5 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 05/01/2024. At 9:25 AM, LPA reviewed 4 of 4 residents records. All resident files were incomplete and missing required documents. At 11:18 AM, LPA reviewed a sample of 4 of 4 resident’s medications. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 12, 2024