Wagaya Assisted Living

Type of visit: Required - 1 Year

On 4/8/2026 at 11:00 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with Administrator Minoru Katsumoto and explained the purpose of the visit. The administrator currently holds a certificate (#7005712740) that expires on 8/9/2026. The facility’s fire clearance was approved for six (6) residents, six (6) may be non-ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of five (5) bedrooms and two (2) bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the shared resident restroom was measured at 106.1 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 4/8/2026. First aid kit was observed to be complete. LPA reviewed five (5) staff and five (5) resident records. LPA reviewed a sample of medication. Continued on LIC809C. Continued from LIC809. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 04/15/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610D Emergency Disaster Plan Liability Insurance THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:30 am, LPA observed unlocked medication in the common area. At 12:15 pm, LPA observed missing CPR training from 0/5 staff members. At 12:20 pm, LPA observed missing first aid training from 0/5 staff members. At 12:30 pm, LPA observed all five (5) residents had missing Appraisal needs and services plans. At 12:45 pm, LPA observed that there wasn't an updated quarterly fire drill conducted. Deficiencies are 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. Exit interview conducted with Minoru. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Apr 8, 2026

Type of visit: Required - 1 Year

On 03/24/2024 around 01:15 PM, LPA arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Minoru Katsumoto, Administrator (ADM) and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of six (6) non-ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, storage, front yard and backyard. All outdoor and indoor passageways are kept free of obstruction. There were no bodies of water. A comfortable temperature for clients is maintained at 73 degree Fahrenheit. LPA observed lighting in all rooms to be adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 106.1. Toilets, hand washing and bathing areas were safe, sanitary and in operating condition. There were supplies of extra hygiene, paper products and emergency water available for staff and clients. There was a minimum one week supply of non-perishables and 2-day of perishables foods. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 07/09/24. First aid kit was observed to complete. Continued on LIC809C... ...continued from LIC809. LPA reviewed 6 client records, and 3 staff records; all are incomplete. -At 03:05 PM, LPA observed resident records incomplete. -At 03:20 PM, LPA observed staff records incomplete. -At 03:30 PM, LPA observed staff records missing required training. -The following forms are to be updated and submitted to CCLD by 03/31/2025: -Resident Roster (Reviewed) -LIC500 Personnel Report (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -Administrator Certificate (Reviewed) to be posted. 7005712740 exp: 08/09/26 -Emergency Disaster Drill Deficiencies observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted, appeal rights, and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, Mar 24, 2025

Type of visit: Required - 1 Year

On 04/10/24 at 2:15PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced required annual inspection. LPA met with Administrator (ADM) and explained the purpose of the visit. ADM currently holds a standard certificate (6019180740) that expires 08/09/24. The facility’s fire clearance was approved for six (6) non-ambulatory residents; two (2) may have hospice waivers. At 2:30PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 73 deg F. Hot water temperature was measured at 115 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 4 staff and 5 resident files. LPA also conducted 2 staff and 2 resident interviews during visit. Continued on next page, LIC 809-C No deficiencies observed during visit. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Residents Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 10, 2024