Facility Evaluation Report

On 02/19/2025 Licensing Program Analyst (LPA) Cheyenne Ratajcak and Licensing Program Manager (LPM) Laura Munoz arrived at the facility unannounced. LPA and LPM met with Administrator Adi Lina Tuiloma and explained the purpose of the visit. LPA and LPM conducted a case management visit to issue citations in relation to complaint control#: 59-AS-20241120120334

During the complaint investigation, it was found that S1 was not criminally record cleared or associated to this facility at the time the incident occurred. The Administrator admitted that the facility failed to request a criminal clearance association for S1. Additionally, the Licensee failed to report the incident related to the complaint investigation.

During today's case management visit, LPA and LPM toured the facility, conducted interviews and records review. The following deficiencies were found:

1) S2 is a live in staff at this facility. S2 has worked 24 hours a day for the past 14 days without any additional staff assistance. There are currently six (6) resident's residing in the facility. Two (2) are receiving Hospice services and bedridden, one (1) of six (6) residents is diagnosed with Dementia and four (4) of six (6) resident's are non-ambulatory. Based on resident's needs and documentation, the department has determined that this facility does not have sufficient staffing. Based on Title 22, Section 87411(a), the facility shall ensure there are two (2) care staff on duty during all waking hours.

2) During a facility walk through, LPA and LPM found chemicals and toxins in the laundry room unlocked and accessible to resident's in care.