A Home for Mom & Dad

Type of visit: Required - 1 Year

On 08/18/25 at 10:00 a.m., Licensing Program Analyst (LPA) Evelin Rios conduct an unannounced annual inspection. LPA was greeted by administrator, Emma Apolinario. Upon entry LPA observed required postings along the walls leading to the kitchen and bedrooms. LPA explained the purpose of the visit. This is a Residential Care Facility for the Elderly (RCFE) with a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident for a total capacity of 6 residents. At approximately 10:12 a.m., LPA along with the licensee representative, Amante Apolinario conducted a physical plant tour inside and out and the following was observed: Kitchen: The kitchen was observed clean and clear of clutter, appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility. Knives were stored in a locked drawer in the kitchen. Medication was observed stored in a locked kitchen cabinet. Two fully supplied first aid kits were observed by the kitchen. Bedrooms: There are five (5) bedrooms designated for residents' use. Bedroom #1 can be shared. Resident occupied bedrooms were adequately furnished, equipped with appropriate bedding and linens, and provided with sufficient lighting. LPA observed a linen closet stocked with additional linens. Bathrooms: There is one (1) bathroom designated for residents' use. The bathroom was adequately stocked with hand soap, toilet paper, and paper towels, and all fixtures were in proper working condition. Hot water temperature read 118 degrees Fahrenheit. (Continued to LIC809-C) Common Areas: These included the living area and dining area. The common areas were clean and appropriately furnished with seating in good repair, televisions, and board games stored in the TV console. The smoke alarms are interconnected. LPA observed a carbon monoxide detector in the hallway leading to the bedrooms. Carbon monoxide detector was functioning properly. Licensee tested smoke detectors at 11:07 a.m., and were observed to be functioning properly. There are two (2) fire extinguishers located by the kitchen and they were observed fully charged one had a purchased date of 11/04/2024. Surrounding Grounds: The outdoor area was free of hazards and has a gazebo with outdoor furniture. LPA observed four (4) sheds used for storage locked an inaccessible to residents in care.. Laundry/Garage: Detergents and cleaning products are kept in the locked laundry room inaccessible to residents. LPA observed a washer. Door leading to the garage was locked. Facility keeps dryer and other cleaning products in the garage. Resident and Staff Files: At 10:30 a.m., LPA conducted a file review of two (2) out of two (2) resident records and two (02) staff records to insure compliance of licensing forms. LPA and the licensee reviewed Centrally Stored Medication and Destruction Records for proper documentation. Facility also keeps Medication Administration Records (MARs). LPA reviewed facility's current liability insurance, infection control plan, emergency disaster plan and last disaster drill conducted on 07/02/25. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Aug 18, 2025

Type of visit: Required - 1 Year

On 08/26/24 at 1:00 p.m. Licensing Program Analyst (LPA) Evelin Rios conduct an unannounced annual inspection. LPA was greeted by administrator, Emma Apolinario. Upon entry LPA observed required postings, hand sanitizer, and a visitor sign in log. LPA also met with Licensee, Amante Apolinario. LPA explained the purpose of the visit. The facility is a two story home with a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident for a total capacity of 6 residents. At approximately 1:05 p.m. LPA along with administrator conducted a physical plant tour inside and out and 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. Medication was observed stored in a locked kitchen cabinet. Bedrooms: There are five (5) bedrooms designated for residents' use. One (1) bedroom is currently vacant. Bedroom #1 can be shared. Rooms occupied by residents were properly furnished with appropriate beddings, linens and with sufficient lighting. Bathrooms: There is (1) bathroom designated for residents' use. Bathroom was properly supplied with hand soap, toilet paper, paper towels and had functional fixtures. Hot water temperature read 118 degrees Fahrenheit. Common Areas: These included the living area and dining area. The common areas were clean and properly furnished. (Continued to LIC809-C) The smoke alarms are interconnected. LPA observed a carbon monoxide detector in the hallway leading to the bedrooms. Carbon monoxide detector was functioning properly. Licensee tested smoke detectors at 2:23 p.m. and were observed to be functioning properly. There are two (2) fire extinguishers located by the kitchen and they were observed fully charged. Surrounding Grounds: The outdoor area was free of hazards and has a gazebo with outdoor furniture. LPA observed four (4) sheds used for storage. Laundry room/Garage: Detergents and cleaning products are kept in the locked laundry room inaccessible to residents. LPA observed a washer. Door leading to the garage was locked. In the garage LPA observed a dryer and cleaning chemicals. Resident Files: LPA conducted a file review of four (4) out of four (4) resident records to insure compliance of licensing forms. Medications: At 3:30 p.m. LPA and the licensee reviewed Centrally Stored Medication and Destruction Records for proper documentation. Facility also keeps Medication Administration Records (MARs). Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Aug 26, 2024

Allegation investigated: Facility staff did not properly discard all contaminated or spoiled food.

On 02/13/2024 Licensing Program Analyst (LPA) Evelin Rios, conducted a unannounced complaint investigation for the allegation listed above. LPA Rios was greeted by staff #1 (S1) who granted access. LPA Rios met with the administrator Emma Apolinario and administrator assistant Amante Apolinario and explained the purpose of the visit. Entrance interviews conducted. LPA toured the facility at approximately 9:40 a.m. observing food and drinks kept in two (2) refrigerator located in the kitchen and a deep freezer in the hallway. At approximately 10:00 a.m. LPA interviewed three (3) out of three (3) residents. At approximately 10:15 a.m. LPA reviewed and obtained the following documents; resident roster, and sample menus. At approximately 10:25 a.m. LPA interviewed S1. Allegation: Facility staff did not properly discard all contaminated or spoiled food. It was alleged the facility is serving milk past expiration date once it is thawed. To investigate the allegation LPA observed six (6) milks with different serving sizes in the refrigerator. One (1) of which was a milk substitute. (Cont. LIC9099-C) Unsubstantiated LPA did not observe any milk in the freezers. LPA observed Five (5) out of the six (6) milks where not past "BEST BY" date. One (1) milk had a "BEST BY FEB 12" date. According to the administrator the milk can be served up to three (3) days past expiration date and then it is thrown out. LPA checked the milk's smell, color and consistency. LPA did not observe it to be spoiled. According to administrators and staff they freeze milk before expiration date and when they need to replenish or replace milk they take it out of the freezer, thaw it in the refrigerator and serve it to residents for approximately one (1) week after thawing. According to administrators they have never served spoiled milk and will throw it away if it is spoiled. LPA noted the milk has a "best by date" and not an "expiration date". Interview with resident #1 (R1) who was able to answer LPA questions, stated they have never been served spoiled milk. Based on LPA's observations and interviews, the allegation, facility staff did not properly discard all contaminated or spoiled food is Unsubstantiated at this time. Exit interview conducted and a copy of the report was given.the state’s words, verbatim · CDSS document, Feb 13, 2024 · control 31-AS-20240207143335

Type of visit: Required - 1 Year

On 02/13/24 at 11:30 a.m. Licensing Program Analyst (LPA) Evelin Rios conduct an unannounced annual inspection. LPA was greeted by staff #1 (S1). LPA observed hand sanitizer, and a visitor sign in log. LPA met with the administrator Emma Apolinario and Amante Apolinario. LPA explained to the administrator the purpose of the visit and an entrance interview was conducted. The facility is a two story home with a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident for a capacity of 6 residents. At approximately 11:32 a.m. LPA conducted a physical plant tour and 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. Medication was observed stored in a locked kitchen cabinet. Bedrooms: There are five (5) bedrooms designated for residents' use. Two (2) of the bedrooms are currently vacant. Bedroom #1 is shared. Rooms occupied by residents were properly furnished with appropriate beddings, linens and with sufficient lighting. LPA observed half bed rails on resident's #2 (R2's) bed. LPA observed half rails on resident #3 (R3) bed. Bathrooms: There is (1) bathroom designated for residents' use. Bathroom was properly supplied and had functional fixtures. Hot water temperature was taken 1:32 p.m. and read 117.8 degrees Fahrenheit. Common Areas: These included the living area and dining area. The common areas were clean and properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. (Continued to LIC809-C) The smoke alarms are interconnected. LPA observed a carbon monoxide detector in the hallway leading to the bedroom. Administrator tested smoke detectors at 11:33 a.m. and were observed to be functioning properly. The fire extinguisher is located by the kitchen observed fully charged with purchase date 08/02/23. Surrounding Grounds: The outdoor area was free of hazards and has a covered patio with outdoor furniture. LPA observed three sheds used for storage. Door leading to the garage was locked. LPA observed a deep freezer with food in a hallway. Detergents and cleaning products are kept in the laundry room inaccessible to residents. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms at 12:00 p.m. LPA's record review for R2 revealed they had an order for bed rails. LPA's record review for R3, R3 did not have an order for bed rails. According to administrator R2 and R3 were on hospice at some point. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. LPA did not observed current first aid and CPR certification for administrator or S1 who was assisting residents during today's visit. Review of S1's records revealed S1 is not associated to the facility. S1 is fingerprinted and background cleared and was at some point associated to this facility when it was going by a different name. LPA did not observe a transfer request on file. According to administrator S1 was just called in as a temp. Medications: At 1:00 p.m. LPA and administrator reviewed medication and medication records for proper documentation. Facility keeps Medication Administration Records (MAR) Deficiencies observed during the visit (refer to LIC809-D). Exit Interview Conducted. Appeal Rights provided. A copy of the report Issued.the state’s words, verbatim · CDSS document, Feb 13, 2024