Sivilay Elderly Home Care

Type of visit: Required - 1 Year

On 12/2/2025 at 4:00pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Brenda Solis, Caregiver. Licensee, Noupane Temple, Licensee, and explained the purpose of the visit. Administrator holds a certificate #7030056740 expires 1/22/2027. LPA spoke with Administrator, Rachael Laine, via telephone. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of five (5) bedrooms and three (3) bathrooms. No bodies of water was observed. A comfortable temperature is maintained at 74 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 147.1 degrees Fahrenheit. Licensee had sign posted that hot water is very hot. Residents’ bathrooms are equipped with grab bars and non-slip mat. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/08/2025. First aid kit was observed to be complete. LPA reviewed four (4) staff records and six (6) resident records all were current and complete. Continued on LIC809. Continued from LIC809. The following forms to be updated and submitted to CCLD by 12/09/2025: LIC610E Emergency disaster plan (all 9 pages) LIC500 (Personnel Record) LIC308 (Designation of facility Responsibility) Liability insurance LPA observed the following deficiencies: At 4:20pm, LPA observed during record review that facility is not conducting fire drill. At 6:05pm, LPA observed medicines were in unlocked kitchen cabinet. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

Allegation investigated: Facility staff financially abused resident

On 7/1/2025 at 10:10am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegation above. LPA met with Brenda Solis, Caregiver and explained the reason for the visit. Licensee, Noupane Temple, arrived at 10:35am. During the course of the investigation the Department conducted interviews with staff, witnesses, resident, obtained and review records. Allegation: Facility staff financially abused resident. Based on interview with W1 there was a safe in R1’s bedroom closet with a very large sum of money which belonged to R1. W1 did not know the exact amount but was told an approximation. W1 stated R1 was admitted into the hospital on 4/15/2025 and the safe was retrieved a couple of days later from the facility. W1 stated after having the money counted it appeared the safe was missing over half of the money. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. amount but was told an approximation. W1 stated R1 was admitted into the hospital on 4/15/2025 and the safe was retrieved a couple of days later from the facility. W1 stated after having the money counted it appeared the safe was missing over half of the money. W1 stated the staff was financially abusing R1 by taking or receiving money from R1 during the time R1 resided at the facility. The LPA interviewed S1, S2, and S3. All stated they had no idea there was money in the safe. S2 stated R1 told her there were pictures in there. S2 also stated R1 would not let any one touch his belongings. The LPA tried to interview R1, but due R1’s diagnosis it was difficult to communicate. During interview with W2 LPA was told the exact amount of money in the safe was unknown. W2 did indicate that R1 handled his own finances. W2 stated he told W1 how much he thought was in the safe. W2 stated R1 had requested W2 to retrieve the safe and bring it to the facility soon after he moved into the facility. W2 stated he did not count the money only took pictures on 12/13/2023 (pictures submitted). W2 stated he knew for sure that R1 had used some of the money for rent, bought food, personal items, and had given W2 a certain amount for helping him. Based upon the information obtained and the interviews conducted during the investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 15-AS-20250430100438

Type of visit: Required - 1 Year

On 12/11/2024 at 3:00pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Noupane Temple, Licensee, and explained the purpose of the visit. Administrator holds a certificate #6065439740 expires 1/22/2025. Administrator, Rachel Laine, arrived at 4:10pm. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of five (5) bedrooms and three (3) bathrooms. No bodies of water was observed. A comfortable temperature is maintained at 72 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 147.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/09/2024. First aid kit was observed to be complete. LPA reviewed four (4) staff records and six (6) resident records. LPA also reviewed medications. Continued on LIC809. Continued from LIC809. LPA observed the following deficiencies: At 3:15pm, LPA observed unlocked cabinet underneath kitchen sink containing knives and soft scrub. At 3:20pm, LPA observed R1 and R4 resides in ambulatory room only. At 3:25pm, LPA observed Pine-Sol in unlocked bathroom cabinet in room #1. Lysol spray sitting on dresser in room #1 and on table in living room. At 3:35pm, LPA observed R4, R5, and R6 all have hospital beds with rails and without a doctor's order. At 3:45pm, LPA observed hot water in residents' shared bathroom was 147.3 degrees F. At 4:00pm, LPA observed during record review none of the residents have an appraisal needs and services plan. At 5:00pm, LPA observed during record review medication administrative records (MAR) were not accurate. Medications were missing from (MAR), MAR didn't show medication was taken, and medication was not in it's original bottle. LPA requested the following documents to be submitted to CCLD by 12/18/2024. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.the state’s words, verbatim · CDSS document, Dec 11, 2024

Type of visit: Case Management - Other

On 7/3/2024 at 3:00pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Noupane Temple, Administrator, and explained the purpose of the visit. LPA received a request for a hospice waiver increase on 6/28/2024. LPA was informed the facility had retained the resident before requesting the waiver. LPA will issue a citation for the facility not requesting the waiver before retaining the resident. The following deficiencies were also observed during the visit: At 3:10pm, LPA observed medications sitting on the kitchen table and counter top. LPA also observed scissors accessible to residents. At 3:20pm, LPA observed during record review S2 not fingerprinted or associated to the facility. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. *An immediate $500.00 civil penalty was assessed on today's date for fingerprint* Exit interview conducted. A copy of the appeal rights, LIC421BG, and this report provided.the state’s words, verbatim · CDSS document, Jul 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(d) · Plan of correction due date: Jul 4, 2024

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement... This requirement was not met as evidence by: Based on record review and observation the Licensee did not comply with the section cited above in having S2 fingerprinted before working, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2024

Plan of correction: Administrator agreed to have S2 fingerprinted and submit copy to CCLD by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Jul 11, 2024

87465 Incidental Medical and Dental Care (h)...requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in requesting a hospice waiver before admitting a hospice resident, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2024

Plan of correction: Administrator locked all medications away and made inaccessible. Deficiency cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87632(a) · Plan of correction due date: Jul 10, 2024

87632 Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. The request shall include, but not be limited to the following: This requirement was not met as evidence by: Based on observation and interview the Licensee did not comply with the section cited above requesting a hospice waiver from CCLD before retaining a resident, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2024

Plan of correction: Administrator agreed to read and review regulation 87632 and submit a self-certification that the facility will abide by the regulation going forward to CCLD by POC date.

Type of visit: Required - 1 Year

On 11/21/2023 at 1:10pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Noupane Temple, Administrator, and explained the purpose of the visit. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of five (5) bedrooms and three (3) bathrooms. No bodies of water was observed. A comfortable temperature is maintained at 69 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 128.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/13/2023. First aid kit was observed to be complete. LPA reviewed three (3) staff files and two (2) files were incomplete, and all three (3) staff was not first aid or CPR certified. LPA also reviewed the resident file and it was current and complete. Continued on LIC809. Continued from LIC809. LPA observed the following deficiencies: At 1:35pm, LPA observed unlocked cabinet containing medication. At 1:50pm, LPA observed shovels, pressure washer, freezer, and a mattress in back yard. At 2:00pm, LPA during record review staff files were incomplete. At 2:05pm, LPA observed none of the staff were first aid or CPR certified. LPA requested the following documents to be submitted to CCLD by 12/04/2023. Resident Roster LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.the state’s words, verbatim · CDSS document, Nov 21, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Nov 22, 2023

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on observation Licensee did not comply with the section cited above in having medications inaccessible to residents which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 21, 2023

Plan of correction: Administrator immediately locked medications in cabinet. Deficiency cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(f)(2) · Plan of correction due date: Dec 6, 2023

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication, nutritional supplements or vitamins... gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidence by: Based on observation Licensee did not comply with the section cited above in having gardening tools, freezer, , pressure washer, and mattress inaccessible and blocking passageway, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 21, 2023

Plan of correction: Administrator agreed to remove items and submit picture to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Dec 6, 2023

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having all staff files complete, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 21, 2023

Plan of correction: Administrator agreed to complete all staff files and submit a self-certification that files are completed to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Dec 6, 2023

87411 Personnel Requirements - General (c) ...staff who assist residents with personal activities of daily living shall receive initial and annual training... (1)Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having staff first aid certified, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 21, 2023

Plan of correction: Administrator agreed to get all staff first aid certified and 1 staff per shift CPR certified and submit a copy of the certifications to CCLD by POC date.

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.