Complaint Investigation Report

197610582-5-1-2025-31-AS-EMIR-DKNVT7-20250818164238

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

04/23/2025 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20250423110515

Facility retains non-ambulatory residents without approved fire clearance.

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Arnold Makura, and advised him of the complaint. It was reported that the facility is licensed for six (6) clients and according to the license the clients should be ambulatory or on hospice but the clients currently in care may not meet those criteria. Today's investigation consisted of interviews with staff and residents, a physical plant inspection and record review. Facility currently has a census of four (4) residents. In addition to interviews with the residents, LPA requested for all four residents to demonstrate whether or not they can get up and go to the bathroom, or exit their rooms on their own. Per resident interview and resident demonstration, LPA was able to identify three (3) of the four residents to be non-ambulatory through interviews and their inability to get up and ambulate on their own. In addition, another Resident, (R6) refer to LIC 811, who just moved out, was also identified as non-ambulatory. Based on the information obtained the above allegation is Substantiated. Citation(s) issued on the 9099D. An immediate Civil Penalty (CP) of $500 for fire clearance issued. Licensee advised that CP of $100 will continue to accrue daily, until this deficiency is corrected. Copy of this report issued.