C & R Home for the Elderly

Type of visit: Required - 1 Year

On 01/29/2026 at 8:30AM, Licensing Program Analyst (LPA) Andrew Christy arrived unannounced to conduct the 1-Year Annual Required inspection. LPA met with caregiver, Nannette Javier, and explained the purpose of the visit. Administrator Precilla San Miguel could not be available and stated Nannette has permission to sign any documents. The facility currently houses four (4) residents with a max capacity of six (6) residents. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. No bodies of water were observed. A comfortable indoor temperature is maintained at 69.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 138.1 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/30/2025. At 9:45AM, LPA reviewed four (4) resident files and five (5) staff files. The emergency disaster plan was last reviewed 01/04/2026. Quarterly emergency drills were last conducted 12/01/2025. A review of resident medications and the Medication Administration Record (MAR) found no outstanding errors. Continued on LIC809C..... Continued from LIC809..... The following deficiencies were cited during the inspection: At 9:30AM, the hot water in the private bathroom of one resident measured 138.1 degrees Fahrenheit. It then measured 126.5 degrees Fahrenheit in the shared residents' bathroom. At 8:45AM, an unlocked cabinet in the kitchen found dish detergent. At 9:30AM, an unlocked cabinet in a resident's private bathroom found bleach wipes. At 10:15AM during file review, it was noted that none of the residents had updated Appraisal Needs And Services forms. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report, along with Appeal Rights, was made available to the caregiver.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Required - 1 Year

On this day, January 7, 2025, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection. LPA met with licensee-administrator, Precilla San Miguel, licensee-administrator and explained the purpose of the visit. LPA toured the facility inside out with Precilla. LPA inspected the kitchen, dining area, activity/game room, bedrooms, bathrooms, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were tested and observed functional. Hot water temperature in one of the bathrooms was tested and measured at 118 degrees Fahrenheit. Fire Drill last conducted 2/20/24. Fire Extinguisher observed fully charge dated 1/30/24. LPA reviewed 3 staff and 5 residents records and interviewed 2 staff and 4 residents. 3 out of 3 staff have CPR and TB on files. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored and Medication Records. Facility does not handle residents' cash resources. LPA observed the following: -at 10:11 a.m. central storage for medications unlocked. -at 10:40 a.m. residents' medications in unlocked kitchen cabinet. -at 10:44 a.m. unlocked refrigerator with residents' medications. -at 10:50 a.m. observed knife in a cabinet unlocked. ..continued on 809C ..continued on 809C -at 10:53 a.m. peritoneal cleanser in one of the resident's bedrooms. -at 11:01 a.m. razor and ointment in the common bathroom. Administrator to submit the following updated/current documents by February 28, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 5. R2 sign documents The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. *An immediate $250.00 civil penalty will be assessed on today's date for reported violation within 12month. * Exit interview conducted. A copy of the LIC421FC, this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 7, 2025

Type of visit: Required - 1 Year

On this day, January 27, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Marta Dacuma, and informed the reason for visit. LPA called and spoke over the phone with Precilla San Miguel, licensee-administrator, who authorized Marta Dacume to with LPA in touring the facility. Administrator arrived at 11:30 a.m. Facility has not submitted the LIC9282 Infection Control Plan. LPA toured the facility inside out with Marta Dacuma. LPA inspected the kitchen, dining area, activity/game room, bedrooms, bathrooms, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested and measured at 113 degrees Fahrenheit. LPA reviewed 3 staff and 5 residents records, and interviewed 2 staff and 2 residents. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored and Medication Records. Facility does not handle residents' cash resources. LPA observed the following: -at 10:38 a.m.,central storage for medications unlocked. -at 10:40 a.m., residents' medications in unlocked kitchen cabinet. -at 10:44 a.m., unlocked refrigerator with residents' medications and staff medications/vitamin supplements in unlocked staff bedroom. ..continued on 809C -at 10:53 .a.m., peritoneal cleanser in one of the resident's bedrooms. -at 11:01 a.m., razor and ointment in the common bathroom. -at 12:55 p.m., LPA checked and verified, and administrator stated they conduct drills 2 or 3x/year; however last recorded drill showed conducted 11/10/21. -at 2;00 p.m., S3 is fingerprinted and cleared but not associated to this facility. -at 2:30 p.m., S2 and S3 do not have LIC503 Health Screening on file. -at 2:45 p.m., S3 has not completed the required 40 hours of training. -at 3:00 p,m,, facility does not have internet service. -at 4:00 p.m, residents (R1, R2 & R3) LIC602A Physician's Report over a year old -at 4:15 p.m., residents' (R1, R2 & R3) LIC625 Appraisal/Needs and Services Plan over a year old. -at 5:00 p.m., R2's medications do not have doctor's order on file. -at 5:10 p.m., R2's two medications not properly recorded on LIC622 Administrator to submit the following updated/current documents by February 10, 2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 5. LIC9282 Infection Control Plan Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Administrator has to leave, and authorized Marta Dacuma to sign and receive this report. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Jan 27, 2024