A & P Care Home for Seniors

Type of visit: Required - 1 Year

On 01/08/2026 at 8:55 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Direct Care Staff, Elizabeth Alba, and explained the purpose of the visit. Administrator arrived shortly after but had to leave during the visit. Administrator gave authorization for staff to sign the report. LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 106 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/06/2026. First kit was observed to be complete. Emergency disaster drill was last conducted on 12/16/2025. At 9:45 AM, LPA reviewed 5 residents records. At 10:22 AM, LPA reviewed 4 staff records and 3 of 4 have current first aid training and 4 of 4 associated to the facility. At 11:45 AM, LPA reviewed a sample of resident’s medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/16/2026: LIC 500 Personnel Report THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:01 AM, LPA observed Clorox Disinfecting Wet Mopping Cloths, scissors in in master bathroom, Clorox wipes under the kitchen sink, and the sharps cabinet in the kitchen unlocked. 9:05 AM, LPA observed Freestyle Lancets, A&D Ointment, Hydrophilic Wound Dressing, Thick It, and Milk of Magnesia unlocked. At 9:10 AM, LPA observed the door alarm in room #3 not working. At 9:12 AM, LPA observed a plant, wheelchair, and a bedside table in front of the sliding door in Room #6. At 9:28 AM, LPA observed rotten cauliflower, wilted cabbage, wilted bean sprouts, and eggs left in the garage. At 9:45 AM, record review revealed that S2 does not have a first aid certification. At 10:30 AM, LPA observed that R1 has a full bed rail and is not on hospice. At 11:45 AM, LPA observed that the Medication Administration Record (MAR) is incomplete. At 12:00 PM, LPA observed that R5 is unable to perform their own glucose test. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights, LIC421FC, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

The state marks this report as 12 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 01/16/2025, at 10:25 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Care Staff, Elizabeth Alba, who phoned the Administrator and explained the purpose of the visit. Administrator gave authorization for staff to sign the report. LPAs toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPAs 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 nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors were in operating condition during visit. First aid kit was observed to be complete. At 10:40 AM, LPAs reviewed 3 staff records and are associated to the facility. At 10:55 AM, LPAs reviewed 5 residents records. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/23/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610 Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Continue to LIC809-C... Continue from LIC809... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:27 AM, LPAs observed the temperature in the thermostat measured at 64 degrees Fahrenheit. At 10:30 AM, LPAs observed the hot water temperature measured at 129.2. At 10:35 AM, LPAs observed unlocked insulin in the fridge and unlocked medication in R5's room. At 10:37 AM, LPAs observed that the window screen in R5's room needs repair. At 10:40 AM, LPAs observed unlocked screwdriver in the backyard. At 10:47 AM, LPAs observed pieces of wood in the backyard that needs to be removed. At 11:00 AM, LPAs observed that all the residents did not have an Appraisal Needs and Services Plan. At 11:05 AM, LPAs observed that R4 does not have a doctor's order for the full bed rails. At 11:10 AM, LPAs observed that S2 and S3 does not have First Aid Certification. At 12:26 AM, LPAs observed that the fire extinguisher was last serviced on 11/22/2022. At 12:27 AM, during record review, LPAs observed that there was no Emergency Drills conducted. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Staff. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

The state marks this report as 9 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

While at the facility reviewing records for the annual inspection, LPA observed Resident 4 (R4) discharge papers dated 7/3/23 indicates R4 developed pressure injury of sacral region stage 3, on 7/16/23 R4 developed decubitus ulcer of sacral region, stage 3 and pressure injury of left perineal ischial region, stage 3 and 1/22/24 indicate R4 with Pressure injury of sacral region, stage 3. R4 is currently in the hospital. The Administrator states there is no home health nurse following up on R4 as of this time. Based on interview conducted by LPA with the Home Health nurse who provided care to R4 in July, R4 was admitted to home health for treatment of stage 3 wound on 7/4/2023 and got discharged on 8/25/23 because the wound healed. A $500.00 immediate civil penalty is assessed on this day. Civil penalty determination related to serious bodily injury is pending. Exit interview was conducted with the Administrator. Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jan 31, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jan 31, 2024

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met ase evidenced by: R4's discharge paper dated 7/16/23 indicates R4 developed stage 3 pressure injury of left perineal ischial region. R4 was admitted back to the facility without home health nurse following up.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: A Non compliance conference (NCC) will be scheduled to address plans of correction.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87615(a) · Plan of correction due date: Jan 31, 2024

87615 Prohibited Health Conditions a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: R4 developed stage 3 pressure injury and was admitted back to the facility without an approved exception which poses an immediate risk to health and safety of clients under care.the state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: A Non Compliance Conference (NCC) will be sheduled to address concerns.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct annual required inspection and met with Administrator Dumitela Dimapilis. LPA explained to the Administrator the purpose of the visit. During the visit, LPA inspected the facility inside and out including but not limited to resident rooms, bathrooms, kitchen, dining, garage and backyard. Hot water measured at 115.8 Fahrenheit. There was sufficient supply of perishable and non perishable foods. LPA observed sufficient supply of warm blankets, sheets and towels available for use of the residents. Administrator states two of six residents are in the hospital. Smoke detectors and carbon monoxide were tested and observed functional. First aid kit was observed to be complete. At around 11:43 am, LPA reviewed 5 resident and 3 staff files. At around 4:00pm, LPA interviewed staff and residents. The following deficiencies were observed: 1. Physical Plant/Environmental Safety - - Unused bed, recliner, mattress, hoyer lift, cart, ripped screen door in the backyard and refrigerator light out were observed during the inspection. 2. Physical Plant/Environmental Safety - - Bathroom disorganized and smelled urine. 3. Physical Plant/Environmental Safety - Comet unlocked under the sink. Lysol unlocked in the unlocked drawer inside the resident's room. 4. Residents with Special Health Needs - R1 developed stage 3 pressure injury in July 2023 but no reappraisal was conducted. continuation on Lic 809D 5. R4 has dementia; last medical assessment was 3/3/2022. 6. Residents with Special Health Needs - Insulin unlocked in the refrigerator was observed during the visit. Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D). Exit interview was conducted with Administrator and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jan 31, 2024