Inspection Report Summary
Most inspections found no deficiencies, including the most recent annual inspection on September 10, 2025, which was clean. Earlier reports showed some issues such as a substantiated complaint in March 2025 where inadequate wound care led to resident hospitalizations and a $500 civil penalty, as well as safety and documentation deficiencies in August 2024 that also resulted in a $500 penalty for an uncleared staff member. Other deficiencies involved environmental safety items like a broken freezer and expired fire extinguisher, but these were less severe and isolated. Several complaint investigations were unsubstantiated, and the facility has shown improvement over time, with the latest inspections free of deficiencies. Overall, the facility’s record reflects mostly compliance with occasional, but addressed, issues.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Sep 10, 2025
Visit Reason
The visit was an unannounced annual required inspection conducted by the Licensing Program Analyst to evaluate compliance with licensing requirements.
Findings
The facility was found to be in compliance with no deficiencies cited. The inspection included a tour of the facility, review of staff and resident files, and verification of emergency and infection control plans.
Report Facts
Staff files reviewed: 2
Resident files reviewed: 5
Fire extinguishers purchase date: Aug 27, 2025
Hot water temperature: 110
Facility temperature: 75
PPE supply duration: 30
Perishable food supply duration: 2
Non-perishable food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Raufat Ikharo | Administrator | Met with Licensing Program Analyst during inspection and identified as infection control leader |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection visit |
| Bennett Fong | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 1
Mar 7, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not ensure a resident's wound care needs were met, resulting in hospitalization.
Findings
The investigation substantiated that staff failed to provide adequate wound care and supervision to a resident, resulting in the resident being hospitalized twice due to worsening pressure injuries. An immediate civil penalty of $500 was assessed. Another allegation regarding improper food service was found to be unsubstantiated.
Complaint Details
The complaint alleged that staff did not ensure the resident's wound care needs were met, resulting in hospitalization. The allegation was substantiated based on interviews, record reviews, and observations. The resident developed stage 3 and later stage 4 pressure injuries due to inadequate repositioning and care. The allegation regarding improper food service was unsubstantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. | Type A |
Report Facts
Immediate civil penalty: 500
Facility capacity: 6
Resident census: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Bennett Fong | Licensing Program Manager | Oversaw the complaint investigation. |
| Raufat Ikharo | Administrator | Facility administrator interviewed during investigation and named in findings. |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 0
Feb 13, 2025
Visit Reason
The inspection was an unannounced Health and Safety check conducted due to the department receiving a priority 2 complaint.
Findings
During the health and safety check, the Licensing Program Analyst observed 2 staff members and 5 residents, toured the facility, and found no imminent health or safety concerns. No deficiencies were cited during the inspection.
Complaint Details
The visit was triggered by a priority 2 complaint. No deficiencies were cited, indicating no substantiated violations.
Report Facts
Staff members observed: 2
Residents observed: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Daisy Panlilio | Licensing Program Analyst | Conducted the unannounced Health and Safety check |
| Raufat Ikharo | Administrator | Facility administrator met during the inspection |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 5
Aug 30, 2024
Visit Reason
The inspection was an unannounced annual required inspection conducted to evaluate compliance with licensing regulations at Kalynna Home.
Findings
The inspection identified several deficiencies including a broken front gate, unlocked bleach in the bathroom, one staff member not fingerprint cleared and associated with the facility resulting in an immediate civil penalty of $500, and personnel records not being available or maintained at the facility.
Severity Breakdown
Type A: 1
Type B: 3
Deficiencies (5)
| Description | Severity |
|---|---|
| Broken front gate | — |
| Unlocked bleach in bathroom | — |
| One staff not fingerprint cleared & associated to facility (Immediate civil penalty of $500 assessed during visit) | Type A |
| Personnel records not available for inspection at facility during visit | Type B |
| Personnel records not maintained at facility | Type B |
Report Facts
Civil penalty amount: 500
Census: 5
Total capacity: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Raufat Ikharo | Administrator | Met during inspection and named as infection control leader |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 2
Sep 1, 2023
Visit Reason
The inspection was an unannounced annual required inspection conducted to evaluate compliance with licensing regulations and facility safety standards.
Findings
The inspection found the facility generally compliant with infection control and safety measures, but two deficiencies were noted: an expired fire extinguisher without a current inspection tag and a broken freezer/refrigerator in the kitchen.
Deficiencies (2)
| Description |
|---|
| Expired Fire Extinguisher (no inspection tag; purchased 10/08/21) |
| Broken freezer / refrigerator in kitchen |
Report Facts
Capacity: 6
Census: 6
POC Due Date: Sep 15, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Raufat Ikharo | Administrator | Met with Licensing Program Analyst during inspection and agreed to plans of correction |
| Daisy Panlilio | Licensing Program Analyst | Conducted the inspection and authored the report |
| Bennett Fong | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Routine
Census: 3
Capacity: 6
Deficiencies: 0
Sep 14, 2022
Visit Reason
The visit was an unannounced infection control inspection conducted as a required one-year routine check.
Findings
The inspection found no deficiencies. The facility had appropriate infection control measures, sufficient food and medication supplies, and an emergency plan including infection control. Updated documents were requested for submission.
Report Facts
Food supply duration: 2
Food supply duration: 7
Medication supply duration: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Raufat Ikharo | Administrator | Facility administrator present during inspection |
| Irene London | Administrator | Met with Licensing Program Analyst during inspection |
| Kristine Emanuel | Staff | Met with Licensing Program Analyst during inspection |
| Daisy Panlilio | Licensing Program Analyst | Conducted the infection control inspection |
| Bennett Fong | Licensing Program Manager | Named in report header |
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 0
Oct 5, 2021
Visit Reason
The inspection was an infection control annual inspection conducted to evaluate COVID-19 mitigation practices and overall facility compliance.
Findings
No deficiencies were cited during this visit. The facility had a COVID-19 mitigation plan in place, adequate PPE supplies, proper emergency/disaster plans, and maintained safe environmental conditions including fire safety and infection control measures.
Report Facts
Capacity: 6
Census: 3
Emergency food supplies: 7
Emergency food supplies: 2
Facility room temperature: 74
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