Divine Mercy Guest Home I

We haven’t transcribed this report yet. The complete document is on the state’s site.

Type of visit: Required - 1 Year

On 10/10/25, Licensing Program Analyst (LPA) J. Duarte arrived unannounced to conduct the required Annual inspection. LPA introduced self, stated the purpose of the visit, and met with Direct Care Staff (DCS) Kevin Clemeno and Merlinda Lauffenburger. Staff contacted Administrator (AD) Susan Baal and stated AD will be reporting to the facility to assist with this inspection. AD Susan arrived shortly after with AD Ulysis Baal. LPA toured the facility with DCS Kevin and AD Ulysis. The facility was observed to be at a temperature of 76 degrees F, in good repair, and no passageway obstructions were observed. The living room has adequate seating for residents. The kitchen was toured and LPA observed an adequate supply of perishable and non-perishable food. The facility stores kitchen knives in a locked kitchen cabinet. Medication is also stored in a locked kitchen cabinet. A fire extinguisher was observed in the kitchen, with a service date of 06/05/25. Resident bedrooms were toured and observed to have beds, dressers, chairs, and adequate lighting. Bathrooms were observed operational, with non-skid mats and grabbed bars. The restrooms hot water measured between 118.6 and 119.5 degrees F. The facility has a laundry room, with a washer and dryer. The facility does their own laundry. The garage was toured and LPA observed detergent, chemicals, and hygiene products locked in a cabinet. The facility has a freezer in the garage with an additional supply of frozen food. Outside of the facility toured and observed to be free of debris. The gate on the side was observed to be self closing. The backyard patio provides shaded seating for residents. The carbon monoxide/smoke detectors were observed operational during inspection. A first aid kit is stored in the kitchen. All resident files and a sample of staff files were reviewed and observed to have required documentation. Continued in LIC 809C... Continued from LIC 809. AD Susan stated that R1 is on hospice. Per R1's physician report, resident is receiving hospice care for a terminal illness. However, AD Susan stated that they do not have a hospice care plan for R1. LPA observed the interior window frames had spider webs and dust. The fan in R2 and R3's bedroom had dust accumulated and the dust was building up on the fan blades. The light fixture in the dinning room also had dust accumulated. Deficiencies are being cited on the attached LIC 809D in accordance to California Code of Regulations, Title 22. An exit Interview was conducted. A copy of this report and appeal rights were provided to AD Susan Baal. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 10/17/25.the state’s words, verbatim · CDSS document, Oct 10, 2025

Allegation investigated: Staff screams at residents.

On 5/22/25 at 2:00 pm Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to investigate and deliver findings on above allegations. LPA met with Staff (S1) John Kevin Clemeno and stated purpose of visit. The Department reviewed records and conducted interviews. R2 stated staff has yelled at resident. Based on the interviews conducted, the preponderance of evidence that Staff yelled at Resient is substantiated. Citation is issued on the attached 9099D. Exit interview conducted. Appeal Rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, May 22, 2025 · control 24-AS-20250519155637

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 5, 2025

(a) Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (1) "Privately operated facility" means a residential care facility for the elderly that is licensed to an individual, firm, partnership, association, or corporation. Based on interview, the licensee did not comply with the section cited that staff yells at resident which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 22, 2025

Plan of correction: Licensee agrees to provide Personal Rights training and will submit completion documents to CCLD by POC due date.

Allegation investigated: Staff advertently cause harm to residents.

On 5/22/25 at 2:00pm Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegations. LPA met with Staff (S1) John Kevin Clemeno and stated purpose of visit. The Department reviewed records and conducted interviews. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued. Exit interview conducted. A copy of this report was distributed to Staff which confirms signature of report. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 22, 2025 · control 24-AS-20250519155637

Type of visit: Required - 1 Year

On 11/4/2024, Licensing Program Analyst (LPA) K.Kaur arrived at the facility unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and was allowed entry into the facility by staff John Kevin Clemeno. Facility Staff contacted Administrator/Licensee, Susan Baal and Ulysis Baal. Licensees arrived a short time later. LPA toured the facility inside and out with staff. Facility observed to be clean, odor free and at a comfortable temperature. Pathways and doors were clear and free from obstruction. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. LPA observed sufficient seating in living room. Fire extinguisher last serviced 3/18/2024. LPA toured 4 resident rooms. Two rooms are single occupancy and two are shared. Resident rooms observed to have the required furnishings. At 11:34 AM LPA observed Bedroom #2 had a window screen that was torn. Tour continued to Kitchen and dining area which were clean and had sufficient seating. LPA observed 7-day supply of non-perishable foods and 2-day supply of perishable foods. Laundry area toured next to kitchen. LPA observed locked closet in the garage that has all chemicals. The exterior tour was conducted. The backyard was observed to have sufficient space and shade under a patio. Backyard gate is self-closing and self-latching. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report and ID Documentation. At 1:15 PM LPA observed no training for restricted health care conditions. Staff files were reviewed for good health and CPR/First Aid. At 2:51 PM LPA reviewed Centrally Stored Medication and Destruction Record (CSMDR) lists, MAR(s) and medication and observed 2 medications from 1 resident were not logged in the log. Medication counts also did not align with medication records for R1. R1 only had centrally stored medication records for current year and did not have previous records. Based on record review LPA observed Facility did not have a care plan from palliative agency for R2 Continued to Next Page Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D. LPA requested the following documents to be submitted to CCL by 11/11/2024: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610E), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview conducted and a plan of correction was reviewed and developed with Licensee/Administrator. A copy of this report and appeal rights was discussed and provided to Administrator, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Nov 4, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.