Yannica Guest Home

Type of visit: Required - 1 Year

On 4-14-2026 at 1:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the Licensee Maxima Martin and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly (RCFE) with a current census of 6. Facility has 4 bedrooms and 2 bathrooms for resident use. 1 extra bedroom is for staff use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 0 ambulatory residents, 4 non ambulatory residents, 1 hospice, and 1 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 73*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 1-6-26. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. {Cont. on 809C} During this inspection 5 resident files and 5 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training requirements. All staff noted on LIC 500 contained criminal background clearances. LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s liability insurance is up to date and within regulatory compliance. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts fire drills quarterly. LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Licenseethe state’s words, verbatim · CDSS document, Apr 14, 2026

Allegation investigated: Staff does not accord resident privacy. Staff is posting videos of residents on social media without resident's consent.

Licensing Program Analyst Noel Wolf Petersen arrived unannouced on 12/12/25 at 12:00pm to conduct a complaint investigation into the above allegations. LPA met with administrator, Maxima Martine LPA asked to review the admission agreement and any attached consents signed at admission. There are videos posted to the Facebook platform by facility staff featuring the facility and two residents for which have the residents have not signed consents to participate in. Administrator Provided there was not a consent form for publishing video of the care home or its residents in the admission agreement, and was aware of the videos and asked for the staff involved to stop. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. 2 citations from the California Code of Regulations,are being cited on the attached LIC 9099D. A copy of the report was read and given to staff. Appeal rights Provided, and exit interview was conducted. Substantiatedthe state’s words, verbatim · CDSS document, Dec 12, 2025 · control 27-AS-20251208105831

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Dec 15, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations... This requirement was not met as evidenced by: record review and interview where it was learned staff making videos featuring the residents and posting to a public platform without the residents consent. This poses an immediate risk to the personal rights of the clients in care.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Administrator asked the staff to stop and take down any videos where clients or thier personal information are present by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80068(f) · Plan of correction due date: Dec 19, 2025

80068 Admission Agreements (f) Modifications to the original agreement shall be made whenever circumstances covered in the agreement change, and shall be dated and signed by the persons specified in (c) above. This requirement was not met as evidenced by: record review and interview where a consent to be have video taken for comercial purposes was not in the admission agreement. This posed a potential risk to the personal rights of the clients in care.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Administrator will commit to either revising the admission agreement to include a consent to video recording residents for commercial purposes or enforce a ban of the practice. LPA will be informed of the decision by the POC date and be sent a copy of the updated house rules or consent form.

Type of visit: Required - 1 Year

On 4/25/25, at 1:30 the Licensing Program Analysts(LPAs) Noel Wolf Petersen and Michael Bilger arrived unnannounced to the facility, to perform an annual inspection. They met with licensee Maxima Martin, and explained the purpose of the visit. This facility is licensed as a Residential Care Facility for Elderly adults a capacity of 6 and a current census of 6. There are zero (0) on oxigen administration, one (1) that is bedridden, four (4) that were on hospice, four (4) that have dementia, and two (2) that are utilizing home health care worker services. The facility Physical Plant was inspected, including but not limited to the kitchen, storage areas, exterior, recreation common area, hallways, resident bedrooms and resident bathrooms. No bodies of water were observed. The required posters were displayed including the ombudsman, federal work poster, and the rights poster. The bedrooms had the required furnishings, and lighting was observed on the way to the bathroom. The premises including the fire exits were free of obstruction. The physical plant is clean and in good repair. The first aid kit was inspected and found to have all the required items, the fire extinguisher was dated 1/2/25 and the resident water temperature measured in the bathroom was within the 105-120*F range per regulation. 2 days of perishable food was observed, 7 days of non-perishable food was observed and in compliance with regulation. Sharps and toxics were locked and stored away from food, inaccessible to residents. The medication storage was locked. Fire alarm was in working order, and fire drills are up to date through last quarter. Phones are in working order and clients have the capacity to take private calls. Continued on C page. The staff records and client records were requested for review, the admission agreement, training documents, plan of operation, infection control plan, first aid documentation, fingerprint clearance for background checks, were found to be complete and in compliance. The client's needs and services plans that designated particular forms of care were met to specification outlined in the documents. An exit interview was conducted with the Licensee and the copy of the report was read and given to the staff.the state’s words, verbatim · CDSS document, Apr 25, 2025

Type of visit: Required - 1 Year

On 11/15/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to conduct an annual inspection. LPA Campbell met with Licensee Maxima Martin and explained the purpose of the visit. Administrator Michell Obtinalla's administrator certificate (# 6066972740) is current and they are associated to the facility. Upon arrival, LPA Campbell observed a one story house surrounded by a white metal fence with sliding access that could be pushed open. The facility is licensed to served 6 ambulatory residents who are 60 and over. Of the 6 residents, 5 may be non-ambulatory and 1 may be bedridden. There is a hospice waiver for 6. The home has four resident bedrooms, 2 bathrooms and a staff room. The entrance of the facility opens into a living room with a couch, mirrors and coffee table. There is then a kitchen and TV room. One resident was observed watching television and singing along with a song. Two informational posters were observed. They included a "See Something, Say Something" poster and a "Long Term Care Ombudsman" poster with contact information. The refrigerator contained three days of perishable foods. One staff was observed mopping the hallway leading to residents rooms. LPA Campbell toured the rest of the facility and observed 6 residents in four bedrooms. Bedroom #2 had a single resident. The rest of the residents were paired up to share. The staff room contained the washer and dryer, cleaning products and the pantry for the facility. There were enough non-perishable foods to last 7 days. All rooms were free of odor and debris. Pathways were unobstructed. A thermostat was set at 68 degrees Fahrenheit (F) which is within the required range of 68 and 85 degrees. A fire extinguisher in the living room was last inspected on January 8, 2024. The facility sketch reflects that no changes have been made to the facility structure. Smoke and carbon monoxide alarms were tested and found to be functioning. Water from the bathroom faucet was observed to be 110.1 degrees F and water from the kitchen faucet was measured at 116.7 degrees F. Both measurements are within the required range of 105 and 120 degrees. During a tour of the backyard, LPA Campbell observed an orange tree bearing fruit. The fire exit was without obstruction. There was a shaded seating area directly outside of the sliding glass doors and several plants ran along the fence border. The backyard was free of debris. LPA Campbell reviewed 5 of 6 client files and 5 of 5 staff files. All clients files were found to be complete. One of the staff files were found to be incomplete, lacked fingerprint clearance and was not associated to the facility. During the visit, LPA Campbell found that the staff person had an incomplete application. Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed or cited and noted on LIC 809D. Note that failure to correct any deficiencies will result in additional civil penalties.the state’s words, verbatim · CDSS document, Nov 15, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with Administrator and explained purpose of visit. Administrator Certificate expires 8/15/2024. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, and outside backyard. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in resident's bathroom at 110.3 degrees Fahrenheit which is within the required range of 105 to 120 degrees. Fire extinguishers last inspected on 1/8/2024. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. medication logs. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 9/2/2023, therefore facility is not in compliance. A facility shall conduct a drill at least quarterly for each shift. LPA reviewed five resident files and five staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents to be submitted via email to community care licensing by February 13, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22, Division 6, Chapter 6, see 809-D for deficiency cited during this visit. Immediate civil penalty issued of $500.00. Failure to correct the deficiency may result in additional civil penalties. Exit interview held with administrator. A copy of reports, civil penalty, appeal rights, and LIC 811 (Confidential Names) were left at facility.the state’s words, verbatim · CDSS document, Feb 6, 2024

Type of visit: Case Management - Incident

LPA Johnson arrived at the care facility unannounced to conduct a case management visit into an incident report received. R-1 AWOL'd from the facility on 9/11/23 and has not returned. According to R1's Physicians report, the area regarding "is allowed to leave the facility unassisted" is blank. The Police were called and stated that if he is not conserved he can leave any time he wants. LPA spoke with Staff about the plans for R1 if he returns. There are no plans. No deficiencies were cited on today's date. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 5, 2023