Arayata Elderly Care

Type of visit: Required - 1 Year

On 09/16/26 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced required annual inspection. Upon arrival, LPA was greeted by staff. Staff contacted the administrator and informed them LPA was at the facility. LPA met with the Administrator, Natividad Arayata and explained the reason for the visit. This is a licensed Residential Care Facility for the Elderly (RCFE) with a Fire Clearance for six (6) bedridden residents and a Hospice waiver for two (2) residents. At 1:45 p.m., LPA conducted a physical plant tour of the facility inside and out and the following was observed: Common Areas: These included the living area and dining area. The common areas were clean, clear of clutter and properly furnished. Dining table and couches sit the capacity of the facility. There is a fire place not in use secured with a screen. LPA did not observe any tripping hazards. In the office area LPA observed a second television and board games for residents to use. Facility records were observed locked in a filing cabinet. Kitchen: Food storage and preparation areas were clean and clear of clutter. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food in the facility. LPA observed an additional refrigerator and freezer in the garage, both stocked with food. LPA observed that all medications were inaccessible in locked kitchen cabinets. LPA observed a fully stocked first aid kit and a small locked refrigerator containing medications that required refrigeration. (Continued on LIC809-C) Laundry room/Garage: Laundry room is kept locked. Chemicals such as laundry detergents are also locked and stored above the washer and dryer. The garage is attached and used for storage. Bedrooms: The facility keeps a comfortable temperature of 75 degrees Fahrenheit. There are five (5) bedrooms designated for resident use of which one (1) is shared. Resident bedrooms were properly furnished with appropriate bedding, linens, sufficient lighting and required furniture. The auditory alarms on all exit doors were on and functional at the time of visit. Bathrooms: There are three full (3) bathrooms for resident use. One (1) full bathroom is located in the shared bedroom. Bathrooms were properly supplied with paper towels, hand soap, toilet paper. At 2:11 p.m., the hot water temperature was measured at 106.5 degrees Fahrenheit within regulation. LPA observed night-lights leading to each bathroom. Outside: LPA toured the outside area and observed the backyard is fenced in and has appropriate outdoor furniture with a shaded covered area for residents. There are no bodies of water. The surrounding grounds were free from obstructions. Facility has one shed outside that is maintained locked used for additional storage. Facility Files: At 2:59 p.m. LPA reviewed five (5) of five (5) resident records to ensure compliance of licensing forms. At 3:23 p.m., LPA reviewed two (2) staff records to ensure forms and training are up to date and in compliance with licensing forms. LPA and Administrator reviewed medication and medication records. The smoke detectors are hardwired and interconnected. Administrator tested the dual smoke/carbon monoxide detectors and they were observed functional. LPA observed a fire door close. The fire extinguisher is located in the kitchen and was observed fully charged with purchase date 09/09/2026. The last disaster drill was conducted on 03/10/26. The facility reviewed their Emergency Disaster Plan on 01/10/2026. No deficiencies observed on todays visit. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Sep 16, 2026

Type of visit: Required - 1 Year

On 07/07/25 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by staff. Staff contacted the administrator and informed them LPA was at the facility. LPA spoke to the administrator designee, Beatriz Vasquez by telephone and informed her the reason for the visit. Administrator, Natividad Arayata will be unable to meet LPA at the facility due to a prior appointment. LPA met with administrator designee at 1:20 p.m., but they could not stay to sign todays report and designated staff, Joana Escario to sign todays report. At 10:36 a.m., LPA conducted a physical plant tour of the facility inside and out and the following was observed: At entry LPA observed appropriate postings on the wall, sign in log for visitors and a digital thermometer affixed to the wall. Common Areas: These included the living areas and dining area. The common areas were clean, clear of clutter and properly furnished. Dining table and couches sit the capacity of the facility. LPA did not observe any tripping hazards. In the office area LPA observed a second television and board games for residents to use. Records were observed locked in a filing cabinet in the office area Kitchen: The kitchen appliances and fixtures were observed functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility, properly stored. LPA observed knives and sharps were stored in a locked kitchen drawer and cleaning supplies were locked in a kitchen cabinet. LPA observed medications were locked in a kitchen cabinet. LPA observed a facility telephone accessible to residents. LPA observed a small locked fridge with medication requiring refrigeration. (Continued on LIC809-C) Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. There is a shaded area for residents. LPA observed a locked shed used for storage. No bodies of water observed. Bedrooms: There are five (05) bedrooms designated for residents' use and one (1) is shared. Bedrooms occupied by residents were properly furnished with appropriate bedding, linens, sufficient lighting and required furniture. Hallway closet by the bedrooms was observed to store extra linens. The facility keeps a comfortable temperature of 76 degrees Fahrenheit. The auditory alarms on all exit doors were on and functional at the time of the visit. Bathrooms: There are three (3) bathrooms. One (1) is located in the shared bedroom. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was taken from two (2) bathroom at 10:55 a.m., and read between 118.8 and 118.2 degrees Fahrenheit, within compliance. The smoke alarms are hard wired and interconnected. Staff tested the dual smoke and carbon monoxide detector at 11:05 a.m., and they were observed to be functioning properly. The fire extinguisher is located in the kitchen and was observed fully charged with purchase date 07/08/2024. Garage/Laundry: The laundry room is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the laundry room locked. LPA also observed extra hygiene products in the laundry room. The locked laundry leads to the garage. In the garage LPA observed a freezer and a second refrigerator with a over flow of food.. Resident Files/ Staff Files/ Facility Files: At 11:09 a.m. LPA conducted a file review of six (6) out of six (06) resident records to insure compliance of licensing forms. Residents' Medication and Medication Records were reviewed for proper documentation. At 12:26 p.m., LPA also conducted a file review of three (03) staff records and facility records to insure forms and training are up to date and in compliance with licensing forms. LPA reviewed facility's Certificate of Liability Insurance, Personnel Report (LIC 500), Infection Control Plan, last conducted emergency disasters drills, and Emergency Disaster Plan (LIC 610E). Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during todays visit. Exit Interview Conducted. A copy of the report Issued.the state’s words, verbatim · CDSS document, Jul 7, 2025

Allegation investigated: Resident sustained an unexplained injury while in care.

On 07/08/2024, Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent unannounced complaint investigation visit. LPA met the administrator, Natividad Arayata and LPA explained the reason for the visit. LPA toured the physical plant of the facility inside and out and did not observe any health and safety issues or concerns. Allegation: Resident sustained an unexplained injury while in care. It is alleged resident#1 (R1) sustained an injury in the facility which caused bleeding from nose and mouth. To investigate the allegation, an initial visit was conducted by LPAs Evelin Rios and Lorena Casillas on 05/22/24. On 05/22/24, between 2:23 p.m. and 3:00 p.m. LPAs interviewed administrator, staff present and one (1) out of four (4) residents. Between 3:00 p.m. to 3:30 p.m. LPAs reviewed and obtained copies of records relevant to the investigation. (Continue to LIC9099-C) Unsubstantiated On 07/08/24 LPA reviewed R1's After Visit/Discharge paperwork from their hospital stay between 05/13/24 to 5/20/24. LPA reviewed R1's medical assessment prior to admittance to this facility dated 04/26/24 and Home Health documentation dated 05/29/24. LPA also interviewed R1 who is no longer at this facility and interviewed R1's responsible person. R1 denied staff at this facility caused them to have an injury resulting in a bloody nose or mouth. R1 also stated they have occasional nose bleeds. Interview with R1's family member corroborates R1 will have nose bleeds due to nasal oxygen cannula use (a devise that delivers extra oxygen through a tube and into the nose). Review of R1's medical assessment reported, resident has a history of falling, respiratory disorders and uses an inhaler and oxygen. Interview with administrator and staff on 05/22/24 revealed R1 has a history of nose bleeds caused by oxygenation through nasal cannula. R1's discharge paperwork from 05/20/24 corroborates R1's use of oxygen and that R1 was admitted due to low oxygen and low blood pressure. According to the administrator they deny causing injury to R1. According to staff #1(S1) and administrator on the day R1 was admitted to the hospital, R1 had not experienced a fall or an injury. Furthermore, S1 states they had checked on R1 who was lying in bed. According to S1, R1 was unresponsive and S1 checked R1's vitals then called the administrator, and contacted 911. Interview with S1 reveals they did not witness R1 actively bleeding or observed dry blood around R1's nose or mouth. Based on interviews conducted, and records reviewed there is insufficient evidence to support the allegation resident sustained an unexplained injury while in care. Therefore, the allegation is Unsubstantiated. Exit interview conducted, a copy of this report was signed and provided.the state’s words, verbatim · CDSS document, Jul 8, 2024 · control 31-AS-20240515150750

Type of visit: Required - 1 Year

On 07/08/24 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by caregiver. Caregiver contacted the administrator and informed them LPA was at the facility. Administrator, Natividad Arayata met LPA shortly after. LPA Rios explained the purpose of the visit. This is a six (6) bedroom three (3) bathroom Residential Care Facility for the Elderly. Facility has an approved fire clearance for 6 bedridden residents for a total capacity of 6. At 9:45 a.m. LPA conducted a physical plant tour to ensure the health and safety of the residents in care. The following was observed: Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen and medications were observed locked in a kitchen cabinet. Bedrooms: There were six (6) bedrooms of which five (5) are designated for residents' use and one (1) is shared. Four of the bedrooms are currently occupied. One (1) room is currently vacant. Rooms occupied by residents were properly furnished with appropriate bedding, linens, sufficient lighting and required furniture. Hallway closet by the bedrooms was observed to store extra linens. The facility keeps a comfortable temperature of 76 degrees Fahrenheit. Bathrooms: There are three (3) bathrooms. One (1) is located in the shared bedroom. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was taken from one (1) bathroom at 10:22 a.m. and read 111.1 degrees Fahrenheit within compliance. (Continued on LIC809-C) Common Areas: These included the living areas and dining area. The common areas were clean, clear of clutter and properly furnished. Dining table and couches sit the capacity of the facility. Living area has a fire place secured with a screen. The auditory alarms on all exit doors were on and functional at the time of the visit. LPA observed two facility telephones operational. The smoke alarms are hard wired and interconnected. Administrator tested the smoke detectors and carbon monoxide detector at 10:37 p.m. and they were observed to be functioning properly. Fire door closed automatically when smoke alarm went off. The fire extinguisher is located in the kitchen and was observed fully charged with purchase date 07/08/2024. Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. There is a shaded area for residents. LPA observed a locked shed used for storage. No bodies of water observed. Garage/Laundry: The laundry room is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the laundry room locked. The locked laundry leads to the garage which is also inaccessible to residents. Staff Files and Facility File: At 10:43 a.m. LPA also conducted a file review of staff records and facility records to insure forms and training are up to date and in compliance with licensing forms. Resident Files: At 11:17 a.m. LPA conducted a file review of five (5) out 0f five (5) resident records to insure compliance of licensing forms. Medications: At 12:00 p.m. Medication and Medication Records were reviewed for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during todays visit. Exit Interview Conducted. A copy of the report Issued.the state’s words, verbatim · CDSS document, Jul 8, 2024

Type of visit: Case Management - Deficiencies

On 05/22/2024, Licensing Program Analysts (LPAs) Evelin Rios and Lorena Casillas conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240515150750. LPA met with Staff #1 (S1) who granted access to the facility. The Administrator met LPAs at 2:30 p.m and LPAs explained the reason for the visit. During the visit, LPAs were informed that R1 had a difficulty breathing on 05/13/2024. 9-1-1 was called and R1 was taken to the hospital. However, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident report was submitted to the Regional Office (RO). LPA informed the Administrator to submit an incident report that occurred for the 05/13/2024 incident involving R1. During the physical plant tour LPAs observed the following: LPA's observed 3 cameras in common areas and one (1) camera in resident#3's (R3's) bedroom. According to Administrator they believe they included cameras in their plan of operation. Administrator could not provide the documentation at time of visit. According to administrator R3's family gave consent to have a camera in her room. According to administrator there is no sound and camera is live streaming only. At 2:23 p.m. LPA Casillas observed a brick outside of the French doors leading to the backyard in bedroom labeled #3 meant to prevent the door from opening. According to Administrator the door does not stay closed and it has been like that for two weeks. According to staff it is used to prevent R2 from wondering. Deficiencies are cited refer to 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, May 22, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: May 23, 2024

87307(d) The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on LPA's observation and interviews Administrator confirmed placing a brick on the outside of the French doors labeled a fire exit, which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 22, 2024

Plan of correction: Administrator removed brick on todays visit. Administrator will submit a receipt or invoice to LPA by POC due date 05/31/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: May 28, 2024

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency...t within seven days of the occurrence ... This requirement is not met as evidenced by: Based on LPA's interviews and record review Administrator confirmed an incident report involving R1 was not sent to CCL in a timely manner, which posed potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 22, 2024

Plan of correction: Administrator will complete the incident report involving R1 to LPA by POC due date 05/28/2024.