Young at Heart RCFE No.5

Type of visit: Case Management - Annual Continuation

On September 1, 2026, at 2:00 PM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Administrator (A1) Glenda Molinyawe and explained the purpose of today's visit. The Administrator holds current certificate #7002475740 expires on October 23, 2027. The facility is licensed for (5) non-ambulatory residents and (1) bedridden resident ages 60 and over. The facility has an approved hospice waiver for (2) residents. The current census is 6 residents. At 2:10 PM, LPA Lopez reviewed (5) resident and (3) staff files. The staff files contained all the required components and reflected ongoing training records. Resident files contained all the necessary components and updated records. LPA reviewed resident medication administration records. The facility documents on a paper Medication Administration Record (MAR) sheet each time medication is dispensed to a resident. Medications were observed to be stored in a locked cabinet. At 2:40 PM, LPA toured the facility with A1. LPA Lopez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; facility bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility was clean, safe, and in good repair. The facility temperature was 72 degrees. LPA toured the resident bedrooms which were observed to be clean and free of hazards. The resident bedrooms were equipped with furniture in good repair. The bedding was clean and rooms were free of odors. LPA observed the facility restrooms. Toilets, hand washing, and bathing areas were sanitary and operational. All showers had non-slip mats and grab bars for safety. Continued on LIC 809-C. The facility has a linen storage with extra bedding and towels available. The dining room and living room areas were clean and free of hazards. Available seating was present to accommodate the current census. The facility fire extinguishers were serviced annually on November 13, 2025. LPA observed smoke and carbon monoxide detectors located on the walls. Alarms were in proper working condition. LPA inspected the kitchen area which was clean and free of odors. The kitchen had at least 2 days of perishable food supply and at least 1 week of non-perishable food items. All kitchen appliances were in operational condition. Sharps and toxins were kept secured in locked cabinets. The exterior of the facility was clear of debris and hazards. There were no bodies of water. LPA observed two shaded seating areas in the backyard. All outdoor passageways were kept free from obstruction. The fence was in good condition. As a result of this annual inspection visit, the facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

On 8/6/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a Required - 1 Year visit. LPA met with administrator, Glenda Molinyawe and explained the purpose of the visit. Administrator Isagani Sisaya is out on vacation. Current LIC 308 designated S1 as Designated Facility Responsible person. Administrator Certificate # for Isagani Sisayan is 7002475740 and expires 10/23/2025. Administrator Certificate # for Glenda Molinyawe is 6052178740. The facility is approved for five (5) ambulatory residents (Age range 60 and over) in which five (5) may be non-ambulatory and one (1) bedridden in bedroom #1 only. Hospice waiver for 2 has been granted. There is currently one resident on hospice. LPA toured the physical plant was conducted with S2 to ensure residents’ health and safety and the facility is in compliance with Title 22 regulations. The following was observed: KITCHEN: Appliances and fixtures were clean and functional. The facility had ample supply of perishable and non-perishable food. Meals are prepared by the Staff. Refrigerator temperature was at 45 degrees F and freezer temperature was at 0 degrees F. Knives and other sharps are locked inaccessible in a drawer. Kitchen and house cleaning supplies are stored in a locked cabinet located under the sink. COMMON AREAS: Common areas include the Living Room and Dining Room. All furniture was observed to be clean and in good condition with enough seating for six residents . There was space to accommodate both indoor and outdoor activities. LPA noted an Activity Calendar and activity storage in the entrance bulletin board. One (1) fire extinguisher was observed throughout the common area and was last serviced on 09/24/2025. Combination smoke detectors and carbon monoxide detectors were working and operational. Continued on 809-C EXTERIOR: Exterior passageways were clean and clear of any obstructions. There is a covered patio area for client and visitor use with furniture observed to be in good condition. Clients are supervised at all times when they are outside. There is one (1) gates with a self-latching mechanism for persons to exit the backyard in emergencies. BEDROOMS: LPA inspected facility bedrooms. The facility has six(6) total resident. All bedrooms were observed to contain furniture, bedding and linens within regulation. Extra linens are stored in the hallway cabinet. Client bedrooms had no visible hazards observed. BATHROOMS: All bathrooms were observed to be clean and sanitary, and supplied with paper and hygiene products. Water temperature was tested and both measured at 114.6 degrees F. MEDICATION REVIEW: LPA reviewed medications which are centrally stored in a locked cabinet in the hallway. All medications were stored and administered in compliance with regulation. RECORD REVIEW: LPA reviewed six (6) resident file records. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Resident files reviewed contained all required documents. LPA discussed the following with S1: (1) The requirement to do a re-appraisal and/or updated physicians report (LIC 602) when there is a change of condition for residents, such as hospice status. (2) Also, hospice status does not automatically constitute bedridden status, appropriate fire clearance would be required for changing a room to bedridden status. LPA reviewed three (3) staff records during today's visit. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All staff records reviewed were in compliance at the time of the visit. RESIDENT INTERVIEWS: LPA Tamayo interviewed two residents who were able to respond verbally, residents voiced no concerns with their quality of care, and said they receive all assistance when needed. continued on 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan as well as the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are within regulation. Both documents were observed to be complete and recently updated. Personal Protection Equipment (PPE) and extra emergency supplies, including emergency food and water, are stored in the garage. The following documents will be email to LPA by 8/21/2025 end of day (5:00 PM): (1) LIC 610 Current Emergency Disaster Plan (2) Proof of Current Liability Insurance (3) Surety Bond (if applicable) (4) LIC 309 Administrator Organization As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Glenda Molinyawe, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Aug 14, 2025

Allegation investigated: Personal Rights: Staff handle resident in a rough manner. Neglect/Lack of Supervision: Staff did not prevent residents from harming another resident.

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Young at Heart RCFE No. 5. on 5/14/25 at 9:00am to inform the licensee of complaint allegations mentioned above. During this investigation LPA Gould interviewed one staff member, three residents and R1's authorized representative (A1) (See confidential name list LIC-811 dated 5/14/25). LPA attempted to contact RP without success. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. Report continued on LIC 9099-C Unsubstantiated The alleged victim, (R1) denied the allegations and provided contradictory statements to the alleged violations. R1 provided statements that staff are kind and gentle when assisting the resident and denied any conflicts or altercations with other residents. All other residents and staff interviewed denied the allegations and provided statements of quality care and supervision. Interviews with A1 support the findings as A1 provided statements to LPA that the facility is providing good care and supervision to R1. A1 has no concerns regarding the care provided to R1 Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of personal rights and neglect/lack of supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 14, 2025 · control 27-AS-20250509164915

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Victoria Brown and Regional Manager (RM) Stephenie Doub arrived on 1/24/25 at 9:45am unannounced to conduct a Case Management visit regarding information received about possible illegal eviction of resident #1 (R1). LPA and RM interviewed residents during this visit. R1 and Staff #1 (S1-R3) was interviewed. LPA received copies of resident file documents. The investigation revealed that the Licensee did not refuse to allow R1 to return to the facility. Licensee indicated that R1 has not paid rent since December 13, 2024. R1 is still residing in the home. Based on interviews the facility will receive an advisory note during this visit. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Jan 24, 2025

Type of visit: Required - 1 Year

On 8/2/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a Required - 1 Year inspection visit. LPA met with facility staff Glenda Molinyawe explained the purpose of the visit. Administrator current certification expires on 10/23/2025. This facility is licensed to serve six (6) non-ambulatory of which one (1) may be bedridden. Hospice approved for two. The current census is 5. LPA toured the facility with Glenda Molinyawe. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, garage, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 117*F which was within the required range of 105-120*F. The temperature inside the facility measured at 71*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Proof of current liability insurance was observed. Report continued on 809-C LPA requested resident and staff files for review. LPA reviewed (2) staff files and (3) resident 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. The following forms and documents were requested to be submitted within 15 days: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. An exit interview was conducted, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Aug 2, 2024