Angels Windsor House

Type of visit: Required - 1 Year

On 09/14/2026 at 10:10 AM, Licensing Program Analyst (LPA) David Doidge arrived to conduct 1-Year Annual Required inspection. LPA met with House Manager Nelson Juta Rivera and explained the purpose of the visit. At 11:20 AM Administrator Haidie Bautista arrived. 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. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the common bathroom was measured at 109.0 degrees Fahrenheit. 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 11/05/2025. First aid kit was observed to be complete. Emergency drills are conducted quarterly, Last frie drill conducted on 09/01/2026 First aid kit was observed to be complete. LPA reviewed five (5) resident records and five (5) staff records; all were complete. LPA also reviewed a sample of residents’ medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 14, 2026

Type of visit: Case Management - Health Checks

On 05/12/2026, at 02:00 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct a health and safety check as a result of a priority 2 complaint. Upon arrival, the LPA informed Caregiver Norgeleen "Gee" Dillo of the purpose of the visit. At approximately 2:25 PM, the LPA spoke briefly over the phone with Administrator (ADM) Haidie Bautista. The ADM arrived at the facility at approximately 4:30 PM. The LPA toured the interior and exterior of the facility, including but not limited to, residents’ rooms, bathrooms, kitchen, common areas, and the backyard. The LPA observed adequate lighting for the comfort and safety of residents in all rooms. Inside and outside areas are free of obstruction and no bodies of water. The temperature in the dining room was measured at 70.7 degrees Fahrenheit and the maximum hot water temperature in the kitchen was measured at 105.5 degrees Fahrenheit. There is more than the minimum of a one week supply of nonperishable foods and 2 days of perishable foods. Smoke and carbon monoxide detectors were in operating condition. The 3 fire extinguishers were fully charged and last serviced on 11/06/2025. The medications were stored in a locked cabinet. First aid kit was observed to be complete. No citations were issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 12, 2026

Type of visit: Required - 1 Year

On 09/10/2025 around 02:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an annual Infection Control Inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Haidie Bautista, Administrator (ADM) was telephoned by the staff member and gave the approval for signing the report. Facility has a COVID-19 mitigation plan, ICP & EDP on file. LPA reviewed the resident staff roster and Emergency Disaster Plan. Facility continues to screen for COVID, has hand sanitizer, COVID-19 signage, and a visitor sign-in log. LPA toured the facility including, but not limited to common areas, bathroom, kitchen, front and side pathways. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap and covered garbage cans. ADM to add paper towels to shared bathroom. There is a surplus of PPE stored centrally located inside the facility that is accessible to all care staff. The facility's temperature was 68 degrees (F) and water in shared bathroom last measured at 109.4. Fire extinguisher was observed full and expires 11/15/24. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. A sample of sic (6) resident and three (3) staff files were complete. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610 Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) Exit interview conducted and a copy of this report provided to Nelson Juta, Staff.the state’s words, verbatim · CDSS document, Sep 10, 2025

Allegation investigated: Staff neglecting care of resident.

On 5/1/2025 at 10:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with House Manager, Nelson Juta and explained the purpose of the visit. During the course of investigation, LPA interviewed 4 residents, 3 staff, witness, and complainant. LPA also obtained and reviewed staff schedule, staff list with contact information, emergency information, physician's report, IPP, needs and service plan, and care notes. Interview with residents revealed that staff would assist residents with showers. R3 stated that staff are good and treats residents equally. Interview with staff indicated there are both female and male staff working at the facility. Facility schedule showed there are 3 staff working at the facility. After reviewing R1's progress notes, R1 had routine visits with the doctors and when R1 had a change in condition. (Continue on LIC9099C...) Unsubstantiated Interview with W1 indicated R1 has lived at the facility for about 15 year and R1 have not expressed concerns to W1 about R1's care provided by facility staff. 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. Exit interview conducted with Haidie Bautista over the phone. Administrator was not able to be at the facility and authorized house manager, Nelson Juta to sign CCLD reports. A copy of this report provided.the state’s words, verbatim · CDSS document, May 1, 2025 · control 15-AS-20240314102857

Type of visit: Required - 1 Year

On 09/18/24 at 10:20 AM, Licensing Program Analysts (LPAs) L. Holmes and Patricia Manalo arrived unannounced to conduct an annual Infection Control Inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. Haidie Bautista, Administrator (ADM) was telephoned by the staff member and arrived about 5 minutes later. Facility has a COVID-19 mitigation plan, ICP & EDP on file. LPAs reviewed the resident roster, staff roster and Emergency Disaster Plan. Facility continues to screen for COVID, has hand sanitizer, COVID-19 signage, and a visitor sign-in log. LPAs toured the facility including, but not limited to common areas, bathroom, kitchen, front and side pathways. LPAs observed mask, cough etiquette, social distancing and hand washing signs posted throughout. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap and covered garbage cans. ADM to add paper towels to shared bathroom. There is a surplus of PPE stored centrally located inside the facility that is accessible to all care staff. The facility's temperature was 68 degrees (F) and water in shared bathroom was 109.4. Fire extinguisher was observed full and expires 11/15/24. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610 Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) Continued on LIC809C... ...continued from LIC809 -At 12:55 PM, LPAs observed the kitchen, bedroom and common areas did not have window screens attached; bedroom #1, 2, 3, 8 & 9. Based on observation, deficiency are cited from Title 22 California Code of Regulations and listed on LIC 9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights, and a copy of this report provided to Haidie Bautista, Administrator (ADM)the state’s words, verbatim · CDSS document, Sep 18, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.