Elle's Home

Type of visit: Case Management - Deficiencies

While at the facility conducting investigation (Complaint Control Number 15-AS-20260503133940) and upon review of records, inspection and interviews, Licensing Program Analyst (LPA) Delmundo observed the following: 1. Scissors in the kitchen and in the tray in the dining area. 2. Unlocked storage for cleaning supplies and ointment out in the open in the backyard. 3. Staff assisted one resident to the bathroom and left other residents unsupervised in the common area. LPA verified, and this staff stated not calling the other staff to supervised the other residents. 4. Resident's (R1) medications that were filled in March 2026 and April 2026 were not listed in LIC622 Centrally Stored Medication and Destruction Record. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $250.00 civil penalty is cited for section 87309(a) for repeat violation within 12 month period. Failure to submit proof of corrections by plan of correction due dates and repeat violations of other deficiencies may result in additional civil penalties. Deficiencies, civil penalty and plan and proof of corrections were discussed with the staff. Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty, LIC9098 Proof of Correction form and copy if this report providedthe state’s words, verbatim · CDSS document, May 7, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: May 8, 2026

87309 Storage Space and Access (a) .... the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if.... ... outside the locked storage. -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above in unlocked scissors and medication room which posed an immediate risks to persons in care.the state’s words, verbatim · CDSS document, May 7, 2026

Plan of correction: Administrator to in-service the staff and submit copy of trainining topic with attendees signatures by 5/08/26. A $250.00 civil penalty is assessed for repeat violation. The first citation was issued on 12/23/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: May 21, 2026

87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. ....... -This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with section above when staff assisted a resident to the bathroom and didn't the other staff to supervise the other residents who were at the common area which posed a potential risk to persons in care,the state’s words, verbatim · CDSS document, May 7, 2026

Plan of correction: Administrator to in-service the staff and submit copy of trainining topic with attendees signatures by 5/21/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(6) · Plan of correction due date: May 21, 2026

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained........ -This requirement is not met as evidenced by: -Based on observation and record review, the licensee did not comply with section above in not recording R1's medications on LIC622 which poses a potential rights risk to person in care.the state’s words, verbatim · CDSS document, May 7, 2026

Plan of correction: Admiinistrator to complete R1's LIC622 and submit copy by 5/21/26.

Allegation investigated: Staff is not physically capable of performing tasks which poses a risk to residents in care.

On this day, March 25, 2026, at 11:20 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Maria Carmela 'Marla' Rocero, administrator (ADM), and informed the reason for visit. Reporting party (RP) stated the when RP visited, there was only one caregiver present on-site. The caregiver was noted that she ambulates with a slow, shuffling gait, which raises concern regarding the ability to respond promptly in the event of a resident emergency. RP also expressed concern if this caregiver would be physically capable of reaching a resident in a timely manner should a fall occur or emergency assistance be required. .....continued on 9099C Substantiated During investigation, LPA conducted interviews, made observation and reviewed residents records. Records showed all 6 residents need assistance with most ADLs and 1 resident (R1) needs assistance in transferring. Although staff (S1) stated she will able to assist the residents in the event of emergency, LPA observed S1 ambulates with a slow, shuffling gait. LPA further observed S1 with shuffling gait when S1 brought the residents in their wheelchair to the dining room. S1 stated she's not able to assist resident (R1) in transferring and provides R1 meals in the bedroom and that it is the administrator (ADM) who transfers R1 from bed to wheelchair. The other staff (S2) also stated giving R1 meals in the bedroom. S2 stated working in the facility on days the ADM is off. ADM confirmed S1 and S2's statements that she is the one who assists R1 and that she's off on Thursdays and Saturdays. Based on interviews and records review, the preponderance of evidence is met, therefore, the allegation is substantiated. Deficiency is cited on Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date may result in civil penalty. Deficiency and plan and proof of correction were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Mar 25, 2026 · control 15-AS-20260319142321

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Apr 8, 2026

87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...... The licensing agency may require any facility to provide additional staff whenever it determines through....... ..... such additional staff for the provision of adequate services. -This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above in S1's capabilty to provide assistance to resident.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: Administrator stated she'll adjust her time and come to the facility early and that addtional staff will cover during her days off. In addition, administrator to update the LIC500 and submit copy along with staff's job duties/responsibilities by 4/08/26.

Type of visit: Case Management - Deficiencies

While at the facility investigating a complaint (Complaint Control # 15-AS-20260319142321) and upon review of records and interviews, Licensing Program Analyst (LPA) Delmundo observed the following: 1. Staff (S1) who stated started working on January 8, 2026, is not fingerprint cleared. 2. Resident (R1) does not have Pre-Admission Appraisal. 3. Medications are pre-poured. Deficiencies are cited on Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for section # 87355(e)(2). Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in additional civil penalty. Deficiencies, civil penalty, plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Mar 25, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Mar 26, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record... -This requirement is not met as evidenced by: -Based on record review and interviews, the licensee did not comply with the section above in having S1 work without being fingerprinted and cleared which poses an immediate safety and/or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: Administrator stated she have S1 fingerprinted and submit proof by 3/26/26. In addition, administrator not to allow S1 work until cleared and associated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Apr 8, 2026

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified....... -This requirement is not met as evidenced by: -Based on record review and interview, the licensee did not comply with the section above in not completing the Pre-Admission Appraisal for R1 which poses a potential health, safety and/or personal rights risks to person in care.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: Admistrator to complete the appraisal and submit copy by 4/08/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Apr 8, 2026

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. -This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section above in pre-pouring residents' medications which poses a potential health and/or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 25, 2026

Plan of correction: Administrator to stop pre-pouring the medications. Self-certification to be submitted by 4/08/26.

Type of visit: Required - 1 Year

On this day, December 13, 2023, at 10:45 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted Geca Bronken, staff. LPA called and spoke over the phone with 'Marla' Rocero, administrator (ADM), and informed the reason for visit. LPA also met with other staff, Rebecca Go. ADM arrived at 11:42 am with other staff, Noel Rocero.. LPA started the inspection with Rebecca Go ad Geca Bronken and continued with ADM. LPA toured the facility inside out. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has smoke and carbon monoxide detectors that were tested, and observed in operating condition. Hot water temperature in the common bathroom was tested, and measured at 111.7 degrees Fahrenheit. Facility conducts disaster drills quarterly, and records showed last conducted December 5, 2025. Fire extinguisher checked, and tag showed serviced December 2, 2025. LPA reviewed 4 staff and 5 residents files, and interviewed 3 residents. Medications checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. .....continued on 809C LPA observed the following: -at 10:58 am, moldy grapes, expired yogurt and sour cream, rotten cabbage and eggplant, tortilla not properly stored (plastic package open), and unlocked medications in the refrigerator. -at 11:00 am, soiled kitchen rug and dirty kitchen floor. -at 11:07 am, unlocked cabinet under the sink where Comet and WD-40 were kept with casseroles and cutting board. -at 11:10 am, very dirty and rusty oven toaster, bread toaster and rice cooker. -at 11:11 am, dirty and moldy dish drainer, greasy cooking range and range hood. -at 11:12 am, medications in the dining area. -at 11:14 am to 11:30 am, cobwebs and spiders all through out the facility. -at 11:22 am, medication in one of the resident's rooms. -at 11:24 am, perineal cleanser, scissors, Calmoseptine ointment in unlocked bathroom cabinet -at 11:31 am, hole on the wall, dusty lights and air vents, moldy shower area/floors in 2 bathrooms, rusted shower curtain bars in the common bathrooms. -at 11:39 am, broken and dirty closet door in another residents' room. Moldy ceiling, spider and cobwebs in this residents' room and bathroom. -cameras that capture audio in all residents' rooms. -at 11:49 am, medications in the refrigerator in the backyard porch. -at 11:50 am, hammer, Miracle gro fertilizer and moldy chairs in the backyard. -at 11:51 am, overgrown weeds about 2 ft tall, rusted metal shelf, crates, piece of metal in the side yard. -at 2:15 pm, staff (S2) only completed 26 hours of the 40 hours required training. -residents' (R2, R3 and R4) half bed rails do not have doctor's orders on file. -resident (R3) has Senna medication but no doctor's order on file. Facility has prescriptions for other 4 (ointments, Glycol, patch) but facility does not have them. Administrator to submit updated/current copies of the following documents by December 27, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 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 penalty. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 13, 2025

The state marks this report as 10 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 12/17/2024 at 10:07 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Maria Carmela Rocero and explained the purpose of the visit. 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 residents’ shared bathroom was measured at 111.5 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 12/24/2024. Emergency Disaster Plan was last posted on 11/08/2020. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/07/2024. At 10:45 AM, LPA reviewed 4 residents records and 3 staff records; all were complete. At 11:15 AM, LPA also reviewed residents medications. The following documents were reviewed and requested during the visit: LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, renewed Liability Insurance and Current Administrator’s Certificate. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 17, 2024

Allegation investigated: Facility not responding to resident's (R1) responsible person's call.

Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Administrator (ADM) Maria Carmela 'Marla' Rocero, and informed the reason for visit. Reporting party (RP) indicated that R1 passed away on August 23, 2024; however, rent for September 2024 was paid in advance by RP. RP stated they reached out to the facility several times regarding refund and the facility is uncooperative. LPA obtained copies of documents including but not limited to conservatorship papers. LPA intervviewed staff (S1) and ADM. S1 stated she received calls from RP. ADM stated S1 relayed to her about RP's call; however, due to the event in her family, she did not and has not responded to RP as of this date, 9/20/24. .....continued on 9099C Substantiated Based on information obtained, the allegation is closed as substantiated. A finding that a complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency is cited per Title 22 California Code of Regulations, and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. LPA conducted inspection and observed the personal properties of resident (R1) are still in the facility. Based on information obtained and due R1's personal properties still at the facility, the allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Sep 20, 2024 · control 15-AS-20240918135606

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a) · Plan of correction due date: Oct 4, 2024

87468.1 Personal Rights of Residents in All Facilities (a) .......(9) To have communications to the licensee from their representatives answered promptly and appropriately. -This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above in not responding to R1's responsible person.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Administrator stated she'll communicate/respond to RP. Proof to be submitted by 10/04/24.

Type of visit: Case Management - Deficiencies

While conducting investigation of a complaint (Control # 15-AS-20240918135606) and upon review of documents and interviews, Licensing Program Analyst (LPA) Delmundo learned that resident (R1) passed away on August 23, 2024, but the facility did not submit Death Report. Administrator (ADM) Maria Carmela 'Marla' Rocero confirmed that she has not submitted the Death Report. Deficiency is cited per Title 22 California Code of Regulations, and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Sep 20, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Oct 4, 2024

87211 Reporting Requirements (a) ...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events .....(A) Death of any resident from any cause regardless of where the death occurred ... including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. -This requirement is not met as evidenced by: -Based on interview, the licensee did not comply with the section above in not submitting Death Report,the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Administrator to submit Death Report and ensure in the future, report will be submitted in timely manner. Proof to be submitted by 10/04/24.

Type of visit: Required - 1 Year

At 11:55 am on this day, December 6, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by Noel Rocero, staff. LPA met with Maria Carmela 'Marla' Rocero, administrator, and informed the reason for visit. LPA also met with other staff, Rebecca Go. Administrator submitted the facility's updated Infection Control Plan which LPA received on August 27, 2023. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. 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 105 degrees Fahrenheit. Facility conducts disaster drills quarterly, and records showed last conducted December 2, 2023. Fire extinguisher checked, and tag showed serviced December 5, 2023. LPA reviewed 3 staff and 5 residents files, and interviewed 2 staff and 2 residents. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. .....continued on 809C LPA received the following updated/current documents: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate The following deficiencies were observed and 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. -at 12:17 pm, rusted metal rack, empty pail, dusty commode, rusted metal, styrofoam container, piece of wood in the backyard. -at 12:30 pm, Glade spray, perotoneal cleanser and scissor in unlocked bathroom cabinet. -at 12:34 pm, Lysol cleaning agent in unlocked ensuite residents' bathroom. -at 2:15 pm, 2 staff First Aid certificates expired and 1 staff no First Aid certificate on file. -at 2:20 pm, S2 has no LIC503 Health Screening and TB test result on file. -at 3:40 pm. R1, R2, R3, and R5's beds have half bed rails but no doctor's order on file. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 6, 2023