Kathleen Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with licensee, Orlando Valera. The purpose for the visit was explained. The facility is licensed to serve 6 non-ambulatory elderly residents. The hospice waiver is approved for 2 residents. The facility consists of (4) resident bedrooms, (1) staff room, (1) office, (2) bathrooms, living room, dining room, kitchen, and attached garage. Facility has operable smoke detectors and a carbon monoxide detector located in the dining area. Knives, cleaning solutions, and disinfectants are locked. The facility has a fire place but is covered. Sufficient food supplies are observed. The hot water temperature was measured within the required range of 105-120 degrees F. The facility accepts and retains residents with dementia. The exit doors have auditory signal devices. There are currently no residents with a restricted health condition or on hospice. The facility has the sufficient amount for liability insurance. LPA reviewed (2) staff files. Staff employed are fingerprint cleared and associated to the facility. Administrator (Orlando Valera) certificate expires on 8/21/28. Staff have valid CPR and First Aid certificates. LPA reviewed (6) resident files and their medications. The files have the required documents. Medications are centrally stored and in their original containers. Staff are administering the medications as prescribed. Facility has sufficient space to accommodate indoor and outdoor activities. The Emergency Disaster Plan is reviewed annually and drills are being conducted at least quarterly. No deficiencies were issued today. An exit interview was held and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Sep 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Victoria Valera and Edmar Limoico, Care Staff and explained the purpose of the visit. Shortly after, Administrator Orlando Valera arrived and assisted LPA with the inspection. The facility is approved to serve elderly clients. Fire cleared for (6) non ambulatory clients. Hospice waiver approved for (2) clients. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: A fire clearance is in place. Fire Drill is conducted monthly and the last drill was conducted on 08/05/2025. Facility has working signal systems in exit points. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (4) resident bedrooms, (1) staff bedroom, (1) office/bedroom, (2) bathrooms, living room with covered fireplace, kitchen, dining area, laundry area in the attached garage and backyard with shaded patio area. There are currently (5) residents, 60 years and older residing in the facility, no one is under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed cameras in the common areas with no audio. Backyard was inspected and has a shaded area and sitting area. There are (2) fire extinguishers in the facility which was purchased on 12/30/2024. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. 10:50am, readings were 114.4 deg. F in bathroom #1 and 113.9 deg F in bathroom #2. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (8) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Five (5) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required Administrator courses and submitted the certification renewal. Administrator's certificate valid through 08/21/2026. Resident Rights-Information: Resident personal rights are posted. Visiting policy is posted at a location that is visible and accessible to residents and families. Facility provides internet services to all residents and have access to the facility phone. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation areas. Incidental Medical Services: All (5) residents' medications were reviewed during the visit.Resident #2 (R2) is taking nonprescription PRN without a written order from a physician and not on the medication list. Resident #1 (R1) has a written order from the Physician for PRN medication, but the label on the PRN medication being administered is incorrect. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications were stored in the office cabinet and inaccessible to residents. First-aid supplies along with a manual are maintained in the facility. Resident Records-Incident Reports: Five (5) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Staff failed to sign the Medication Administration Record (MAR) on the correct time and date (8am/Sep. 4, 2025) for one of the resident (R2). Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. The facility conducts emergency drill on a monthly basis. Last fire drill was conducted on 08/05/2025. Residents with SHN: None of the residents is under hospice care. Physician orders for use of half bed rails were reviewed in (5) residents files. (1) out of (5) residents did not have a bed rail physician's order on file. Deficiencies cited, Technical Violation issued. Exit interview and a copy of this report along with the appeal rights was provided to the Administrator, Orlando Valera.the state’s words, verbatim · CDSS document, Sep 4, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA arrived unannounced and met with licensee, Orlando Valera. The initial inspection began on 8/27/24. During the visit today, LPA inspected the remainder of the domains. Staffing: The administrator's (Orlando Valera) certificate expired on 8/21/24. The administrator had submitted the renewal via mail and is pending approval. Staff employed are over the age of 18 and are fingerprint cleared. Personnel Records-Training: LPA reviewed the Administrator and 2 other staff files. There are sufficient annual training on file. CPR & First Aid certificates are current for all 3 staff. Resident Records-Incident Reports: LPA reviewed 6 resident files and they have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report, Resident appraisal, and Resident rights. Resident Rights-Information: The Local Ombudsman and Residents personal rights information are posted at the facility. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical/mental capability. Incidental Medical & Dental: The medications are centrally stored in their original containers. LPA reviewed 6 residents' medications and no discrepancies were found. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and procedures. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. There are currently 2 residents in hospice. No deficiencies issued today. An exit interview was held and a copy of this report was given to the licensee.the state’s words, verbatim · CDSS document, Aug 30, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Cynthia Chan conducted an annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPA arrived unannounced and met with licensee, Orlando Valera. The purpose of the visit was explained. The facility is approved for (6) non-ambulatory elderly residents. There is a hospice waiver approved for 2 residents. LPAs toured the facility and inspected the following domains: Infection Control: The facility staff are performing hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting daily. Facility continues to follow the infection control plan. Physical Plant & Environment Safety: The facility consists of 4 resident, 2 staff rooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. Extra linens are observed. Facility has an operable smoke detector in each room and a carbon monoxide detector. Knives and cleaning solutions are locked and inaccessible to residents. There are no swimming pool or bodies of water on the premises. Operational Requirements: There are currently (6) residents residing at the facility and (2) are on hospice. The facility has the adequate amount for liability insurance. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. There is an extra refrigerator in the garage. Foods are properly stored in the refrigerators. LPA will return another day to complete the remainder of the domains. There are no deficiencies issued today. A copy of this report was given to the licensee.the state’s words, verbatim · CDSS document, Aug 27, 2024