Heather's Care Home

Type of visit: Required - 1 Year

On 10/24/2025 at 10:30 AM, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with the Administrator Michelle Cajucom and explained the purpose of the visit. Administrator certificate is # is 7002125740 with an expiration date of 12/7/2025. The facility’s fire clearance was approved for all six (6) non-ambulatory and two (2) hospice waiver. The facility is vendorized by the Regional Center of the East Bay (RCEB). LPA toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms. Three (3) 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. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature was measured at 114 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. Centrally stored medications were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were tested and observed in operating condition. Fire extinguisher was last serviced on 12/10/2024. First aid kit was observed to be complete. Fire drill was last conducted on 9/9/2025. At 11:00 AM, LPA reviewed P&I money and log with Cajucom. The facility has sufficient surety bond to cover cash being handled. At 11:10 AM, LPA reviewed medications and Medication Administration Record (MAR) with Cajucom. At 11:50 AM, LPA reviewed 4 staff records and 4 client records. All 4 staff are fingerprint cleared and associated to the facility. They have current first aid and CPR training. ******continuation on Lic 809C****** Updated copies of the following documents were requested from the facility and are to be submitted to CCL by 10/30/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Infection Control Plan Registration/Insurance/Driver's License Surety Bond There is no deficiency noted for this visit. A copy of this report was provided to Cajucom.the state’s words, verbatim · CDSS document, Oct 24, 2025

Type of visit: Required - 1 Year

On 12/17/2024 at 2:30 PM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Direct Care Staff, Bernadeth Relon, who phoned the Administrator and explained the purpose of the visit. Administrator certificate is current, Administrator # is 7002125740. The facility’s fire clearance was approved for all six (6) may be non-ambulatory and two (2) hospice waiver. LPAs toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 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. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 115.5 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. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 12/10/2024. First aid kit was observed to be complete. Earthquake drill was last conducted on 11/09/2024. Fire drill was last conducted on 05/04/2024. At 2:42 PM, LPAs reviewed 5 clients and 4 staff records. LPAs reviewed client's P & I money with logs. The facility has surety bond sufficient to cover amount of cash being handled. At 03:02 PM, LPAs reviewed 4 staff records and 4 of 4 have current first aid training and all 4 are associated to the facility. At 3:20 PM, LPAs reviewed resident’s medications. All records were observed to be complete and up to date. 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 12/26/2024: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT: At 2:30 PM, LPAs observed garden tools such as rake, spade, and etc., unlocked in the backyard. 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 Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 17, 2024

Allegation investigated: Staff are not properly cleaning resident after bowel movements Staff are double diapering resident

On this day at around 2PM, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct investigation on the above allegations and met with Administrator Jonas Depasupil and Michelle Vega-Cajucom. LPA explained to both Administrators the purpose of the visit. During the visit, LPA interviewed both Administrators. LPA obtained the following records for Client 1 (C1): IPP, Physician's Report, Medication Administration Record (MAR), doctor's order and email correspondence between day program and facility. Based on C1's Physician's Report dated 3/1/2024, C1 is incontinent for both bladder and bowel. C1 experiences occasional bowel/bladder incontinence. A review of C1's MAR indicates that C1 is on Miralax on a daily basis and takes Hydrochlorothiazide 2x a day. continuation on Lic 9099C Unsubstantiated continuation from Lic 9099 S2 states that the Miralax has been very effective in preventing C1 from getting constipated and the Hydrochlorothiazide in stabilizing C1's blood pressure. Both Administrators state that C1 has been using a diaper and a chucks pad since C1 came back to the program after the pandemic due to C1's occasional incontinence. The chucks pad is an extra protection in case C1 gets a bowel/urine accident while on transit. They both state that C1 gets cleaned thoroughly and goes to the bathroom at least 30 minutes before C1 gets picked up by the transportation. And that C1 takes a shower every morning. Based on interviews and record reviews conducted, the above allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiency is noted for this visit.the state’s words, verbatim · CDSS document, May 29, 2024 · control 15-AS-20240523143714

Type of visit: Required - 1 Year

On 12/7/2023 at approximately 10:15 am, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA met with Jonas Depasupil, Administrator. The facility is a Level 4C home vendorized by the Regional Center of the East Bay (RCEB). The facility has an approved fire clearance for six non ambulatory clients. LPA with Depasupil inspected the facility inside and out including but not limited to three client bedrooms, two bathrooms, kitchen, common areas, garage and backyard. All outdoor and indoor passageways are kept free of obstruction. There were no bodies of water observed. LPA observed medications were locked in a cabinet in the hallway. Chemicals were locked in the garage. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the kitchen was measured at 116 degrees Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. Hygiene items, extra linens and toiletry supplies were checked and observed sufficient. Fire extinguisher was last serviced on 12/15/22, smoke detectors and carbon monoxide were operational. Last fire drill was conducted on 8/30/23. First aid kit was inspected and observed complete. Food supplies were sufficient to meet 2-day perishable and 7-day non-perishable requirements. At 11: 30 am LPA reviewed five(5) client files and four (4) staff files. All staff have criminal record clearance and are associated to the facility. At 1pm, P&I monies were reviewed with the Administrator. Facility was unable to provide surety bond during the visit. continuation on Lic 809C Administrator states that the facility has a $5,000 surety bond and will submit a copy to LPA with Lic 400 by Dec 8, 2023. The following deficiencies were observed: at around 10:40am, LPA observed screen doors ripped or have tiny holes last fire drill was conducted on August 30, 2023 The following forms were provided to LPA during the visit: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Copy of liability insurance Car insurance/registration/copy of driver's license Deficiencies were cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted with Depasupil. Appeal Rights and a copy of this report were provided.the state’s words, verbatim · CDSS document, Dec 7, 2023