Zion Residential Care

Type of visit: Required - 1 Year

On 07/02/25, at 12:25pm, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Jenneth Aguilar the administrator was called and arrived about ten (10) minutes later. LPA asked for the census, resident, and staff rosters. The administrator stated there is no residents and/or staff at the facility. The facility has been licensed as a Residential Care Facility for the Elderly. The physical plant was toured inside and outside at 12:30pm. It is a single, story home. Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. There is one refrigerator in the kitchen area. The cabinets have canned goods. Sharps are kept secured and locked in one of the cabinets on your right-hand side. The medication cart is kept in the kitchen area locked and secured. The medication cabinet is currently empty with no medications due to the facility having no residents. There is one washer and dryer kept outside behind the kitchen area. The fire extinguisher was observed to be full and dated February 2026. LIC 809C-continued Living Room and Dining Room: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The dining room area has six (6) chairs for residents and a television. The facility temperature is at 75 degrees Fahrenheit. There is a fireplace that is covered. No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were tested and operational. They are hardwired. The facility has a current telephone landline and internet access. Bedrooms: Facility has six (6) bedrooms and were toured. The bedrooms are fully furnished with proper lighting and bedding. Four (4) of the bedrooms are single, occupancy. One (1) of the bedrooms can be used as a shared and has a private bathroom. There is one (1) staff bedroom currently occupied by staff. There is another bathroom for staff and residents use in the hallway. There are two (2) cabinets that have extra linen, PPE’s and incontinence. The bathrooms had proper grab bars, non-skid mats. The bathrooms contained a trash can with tight-fitting lid. Hot water was tested and measured 108.2 within regulations. Outside/Backyard: The toxins are kept in a storage shed outside locked and secured. The garage is detached from the house with an extra refrigerator. The outside/backyard has furniture for residents to have proper seating. The facility has no signal system. There is no bodies of water. Administrative: The Insurance plan is updated and expires 02/2026. The disaster plan, Resident Rights, licensee certificate, Ombudsman, and Facility Sketch are against the wall at the entrance of the facility. An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Jul 2, 2025

Allegation investigated: Staff records are not kept on file.

On 04/21/25, at 09:20am, Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Jenneth Aguilar. LPAs explained the purpose of this visit was to gather information, interview staff and deliver findings for this complaint. To investigate the allegation(s), LPAs asked for the census, staff, and resident rosters. LPAs conducted a physical tour and interviewed staff. LIC 9099C-continued Substantiated Regarding the allegation: Staff records are not kept on file. Interview with Staff #2 (S2) revealed that Staff 1(S1) did not work at the facility between the dates of (Sept 2022 - March 2023) but was a volunteer. S2 stated S1 was a babysitter for their child. Record review on Guardian and Licensing Information System (LIS) revealed that S1 was on the facility's roster as an employee. Further interview, with the S2 revealed that they accidentally registered S1 as an employee instead of a volunteer and they stated, "It was my fault". When LPAs requested S1's file, S2 could not provide the file. Based on LPA's interviews and record reviews the facility failed to provide the file for S1, therefore the above allegation(s) above is SUBSTANTIATED at this time. Exit interview was conducted, a citation was issued for the above allegation(s), the appeals rights and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Apr 21, 2025 · control 31-AS-20250416090928

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(h) · Plan of correction due date: May 5, 2025

87412 Personnel Records (h) All personnel records shall be retained for at least three (3) years following termination of employment. This requirment is not met by: Based on record review and staff interview the Administrator failed to provide the staff's file for S1 and had them listed as an employee on Guardian/Licensing Information system.the state’s words, verbatim · CDSS document, Apr 21, 2025

Plan of correction: Administrator will send the file for S1 by the end of the POC date. POC Date:05/05/25

Type of visit: Required - 1 Year

On 08/13/24, at 9:20am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Upon arrival, LPA met with Caregiver, Ernesto Dizon. Jenneth Aguilar the administrator was called and later arrived. LPA asked for the census, resident, and staff files. The facility has been licensed as a Residential Care Facility for the Elderly. The physical plant was toured inside and outside at 10:25 am. Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. There is one (1) refrigerator in the kitchen area. The cabinets have canned goods. Sharps are kept secured and locked in one(1) of the cabinets on your right-hand side of the kitchen. The medication cart is kept in the kitchen area locked and secured. There is one (1) washer and dryer kept in the kitchen area. The fire extinguisher was observed to be full and dated February 20, 2024. Living/Dining Room: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The dining room area has six (6) seats for residents and a television. The living room area has proper seating and a television. The facility temperature is at 75 degrees Fahrenheit. There is a fireplace that is covered. No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were tested and operational. The facility has a current telephone landline and internet access. LIC 809C-continued Bedrooms: Facility has six (6) bedrooms and were toured. The bedrooms are fully furnished with proper lighting and bedding. Four (4) of the bedrooms are single, occupancy. One (1) of the bedrooms can be used as a shared and has a private bathroom. There is one (1) staff bedroom currently occupied by staff. There is another bathroom for staff and residents use. There are two (2) cabinets that have extra linen, PPE’s and incontinence. The bathrooms had proper grab bars, non-skid mats. Bathroom contained a trash can with tight-fitting lid. Hot water was tested and measured within regulations of 110. Outside/Backyard: The chemicals/toxins are kept in a storage shed outside locked and secured. The garage is detached from the house with an extra refrigerator and storage supplies. The outside/backyard has furniture for residents to have proper seating. The facility has a signal system. There is no bodies of water. Administrative: There is an annual fee that is due right now of $495.00 due by 09/29/24. The Insurance plan is updated as of 02/12/2024, disaster plan, Resident Rights, licensee certificate, Infection control, Ombudsman, and Facility Sketch are against the wall at the entrance of the facility. There is also a closet at the entrance of the facility. An exit interview was conducted, no citations() were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Aug 13, 2024

Allegation investigated: Facility staff are not properly trained. Facility staff are not providing adequate supervision.

On 03/27/2024 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced subsequent complaint visit. Upon arrival LPA met with staff#2 (S2) and staff#3 (S3). S2 contacted the Administrator, Jenneth Aguilar by telephone and LPA explained the purpose of the visit. Janneth met LPA shortly after. Entrance interview conducted. At approximately 9:40 a.m. Licensing Program Analyst (LPA) Evelin Rios, conducted a physical plant tour of the facility to ensure the health and safety of the residents in care and interviewed the administrator. LPA did not observe any issues or concerns. From approximately 10:00 a.m. to 10:30 a.m. LPA conducted interviews with two (2) out of three (3) residents in care. One (1) out of the three (3) residents was sleeping. LPA also conducted interviews with the (2) staff present. At approximately 11:00 a.m. LPA reviewed and obtained copies of S1 and S2 training records, resident roster and LIC500. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) Allegation #1: Facility staff are not properly trained. It is alleged staff #1 (S1) has not received the required training prior to starting at the facility. To investigate this allegation LPA Patrick Shanahan, conducted an initial complaint investigation on 10/11/2022. LPA Shanahan interviewed the administrator Janneth, and staff#4 (S4) during the visit. LPA Shanahan also reviewed and collected copies of S1’s training. LPA Rios on 03/27/2024 interview with administrator revealed she does not allow staff to work with residents until the required training and shadowing is complete. LPA Rios also conducted staff record review for the two staff present. Review of staff training records indicate S1 has the initial training required before providing care to residents. Based on interviews and record review this allegation is deemed Unsubstantiated at this time. Allegation #2: Facility staff are not providing adequate supervision. It is alleged staff was sleeping while the residents were awake. To investigate this allegation LPA Patrick Shanahan, conducted an initial complaint investigation on 10/11/2022. LPA Shanahan interviewed the administrator Janneth, and staff#4 (S4) during the visit. Interviews on 10/11/2022 denied the allegation. On 03/27/2024 LPA Rios interviewed administrator, two (2) staff present and two (2) out of three (3) residents. Interviews with administrator and staff revealed they do not sleep or nap while providing care. Interviews with staff revealed if they need to take a break they use the staff room away from residents and not in the living room and another staff is present to cover break and lunch time. Interview with two (2) residents revealed they have no issues about the care and supervision provided. Furthermore resident interviews revealed they have not witnessed staff napping or seeping while they are awake. Based on interviews and record review this allegation is deemed Unsubstantiated at this time. No deficiencies cited. Exit interview conducted. Report signed and delivered.the state’s words, verbatim · CDSS document, Mar 27, 2024 · control 31-AS-20221006193944

Type of visit: Required - 1 Year

On 01/09/24, at 11:50 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. Upon arrival, LPA met with Caregiver, Evelyn Bautista. Jennet Aguilar the administrator was called and later arrived. LPA asked for the census, resident, and staff rosters. The caregiver stated there is no residents at the facility. LPA asked the caregiver what the reason was for no residents being at the facility and the caregiver stated, “they are in the hospital.” The administrator confirmed that the residents never returned from hospital. The administrator also stated, “I emailed the licensee department to let them know, I haven’t had anyone for over six (6) months. The facility has been licensed as a Residential Care Facility for the Elderly. The physical plant was toured inside and outside at 12:15 p.m. Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. There is one refrigerator in the kitchen area. The cabinets have canned goods. Sharps are kept secured and locked in one of the cabinets on your right-hand side. The medication cart is kept in the kitchen area locked and secured. There is one washer and dryer kept in the kitchen area. The fire extinguisher was observed to be full and dated March 2023. LIC 809C-continued Common Area: LPA observed the living room and furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The dining room area has six (6) seats for residents and a television. The living room area has proper seating and a television. The facility temperature is at 70 degrees Fahrenheit. No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were tested and operational. The facility has a current telephone landline and internet access. Bedrooms: Facility has six (6) bedrooms and were toured. The bedrooms are fully furnished with proper lighting and bedding. Four (4) of the bedrooms are single, occupancy. One (1) of the bedrooms can be used as a shared and has a private bathroom. There is one (1) staff bedroom currently occupied by staff. There is another bathroom for staff and residents use. There are two (2) cabinets that have extra linen, PPE’s and incontinence. The bathrooms had proper grab bars, non-skid mats. Bathroom contained a trash can with tight-fitting lid. Hot water was tested and measured within regulations. Outside/Backyard: The toxins are kept in a storage shed outside locked and secured. The garage is detached from the house with an extra refrigerator. The outside/backyard has furniture for residents to have proper seating. The facility has no signal system. Administrative: There is no annual fee that is due right now. The Insurance plan is updated, disaster plan, Resident Rights, licensee certificate, Infection control, Ombudsman, and Facility Sketch are against the wall at the entrance of the facility. An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Jan 9, 2024