Acacia Guest Home-anaheim

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Required – Annual Inspection at the facility. Upon arrival, LPA was greeted and granted entry by Care Staff Briyan Yosjaya, who was informed of the purpose of the visit. Administrator (AD) Jacklyn Concepcion arrived shortly thereafter. During the inspection, LPA, accompanied by facility staff, conducted a comprehensive tour of the interior and exterior of the facility, including common areas, residents’ bedrooms, kitchen, and garage. The facility is a single-story home consisting of four bedrooms and two bathrooms, with a detached garage. At the time of the visit, six residents were in care. LPA observed the kitchen area and confirmed that all appliances were operational. Knives and cleaning chemicals were properly secured in a locked kitchen cabinet, inaccessible to residents in care. Restroom #1 was found to be non-operational due to a leaking showerhead from the main pipe and a clogged bathtub drain. Additionally, the shower lacked a non-slip mat. Water temperature in both restrooms measured between 107.6 and 109.6 degrees Fahrenheit, which is within the regulatory range. LPA toured the exterior of the facility and observed a shaded seating area available for residents’ use. All emergency exits were found to be unobstructed and easily accessible. Upon inspection of food supplies, it was determined that the facility did not maintain the required two-day supply of perishable food and seven-day supply of non-perishable food as required by regulation. {***CONTINUE***} 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Additionally, the facility did not have an emergency supply of food and water available. Smoke detectors and carbon monoxide detectors were tested and found to be operational. The fire extinguisher was fully charged, with a purchase date of August 29, 2025. A review of two resident files and two staff files indicated that all required documentation was current. LPA observed that the facility’s posted PUB 475 was not in compliance with the required regulatory size of 20 x 26 inches. Review of the emergency drill log showed that the most recent drill was conducted on September 23, 2025. Based on observations made during today’s inspection, deficiencies are being cited in accordance with Title 22, Division 6 of the California Code of Regulations. This report was reviewed with the Administrator, and a copy of the report and appeal rights were provided to the Administrator at the conclusion of the visit.

LPA toured the inside and outside of facility with (AD) and observed the following: The facility is a 4-bedroom, 2-bathroom, 1-story house with detached garage that is being used for storage. Resident Bedrooms: the 3 resident bedrooms are spacious and have all required furniture per regulations: Lights, chairs, linens, and storage for each resident bedroom. LPA found a pair of scissors, Skintegrity Spray for wounds and Clorox disinfectant wet napkins in one of the resident’s rooms. AD immediately removed and locked the items. The fourth bedroom is for staff and also had all required elements per regulation. LPA toured the kitchen and observed grease and left over oil splashes on stove and around the oven; stove had five burners and only 4 worked due to grease and oil being stuck. AD tried to clean stove and was unable to make the burner work. 7 kitchen drawers were loose and not intact in place. LPA checked restroom one and observed chipped paint in the shower area. Shower had a glass door which had mold and mildew around the rim and edges of the door. LPA checked water temperature and it was tested between 109.9 and 110.9 Degree Fahrenheit. LPA checked Carbon Monoxide, Smoke Detectors and all tested operational. Fire Extinguisher was in the green, fully charged, and last checked on July 17 th , 2024. LPA checked food sully and the facility had the 2 days perishable and 7 days nonperishable food supply per regulation. LPA toured the outside of the facility and observed a shaded area with chairs and space for residents’ activities and enjoyment. LPA found full bottle of Windex, and Clorox in a blue bucket and accessible to residents in care. During record review, LPA observed that fire drills are conducted monthly. Staff records showed all required documentation including valid CPR.(..CONTINUE 809C....) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA checked three residents’ file and observed that 2 out of 3 residents had dementia and none had a recent physician report: Resident (R1) last physician report was 8/14/23 and R2 physician report was 06/08/2023. Based on the observation made during today’s visit, deficiencies are being citied today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to the AD.

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a Case Management visit for the purpose of issuing deficiencies observed. LPA met with Caregivers Briyan Yosjaya and Brandy Guinto. While at the facility, LPA reviewed the staff members associated at the facility. LPA observed a staff member working at the facility at the time of the visit was not associated to the facility. LPA verified the staff member is cleared to work in CCLD facilities, but the staff member was not associated to the facility. A citation is being issued. While at the facility, LPA observed unlocked medication in the facility refrigerator. LPA determined the medication was accessible to residents in care. A citation is being issued. While at the facility, LPA observed two doors blocking emergency exits from the facility. LPA noted doors were not blocked in a way that prevents any resident from accessing the rest of the facility. A citation is being issued.