Instacare, A Place Called Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit and was greeted by the staff Annel Denis who called the Administrator Christine Bwogi. Ms. Bwogi designated Ms. Denis to sign the report. LPA explained the reason for the visit. The facility is fire cleared for six (6) non-ambulatory residents, Hospice waiver for two (2) residents. At 12:19 PM, LPA conducted the physical plant tour with the staff and observed the following: The facility is a single storey building with five (5) bedrooms and two (2) bathrooms on one (1) shared and four (4) private room. Dual smoke and carbon monoxide alarms were tested and observed to be operable. Common Areas – The family room, living room, dining room, and kitchen were inspected. The family room and activity room were furnished with comfortable seating and a television. The dining room contained a dining room table and chairs. Fire extinguishers were located by the kitchen and the bedroom hallway and last bought on 03/07/26. Medications: LPA observed the resident medications and first aid kit were safely locked in a cabinet inside the Laundry room. Kitchen: LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. Dishwashing liquid and other cleaning agents were observed locked underneath the kitchen sink. Laundry Room is located adjacent to the kitchen and was observed to be locked during visit. Laundry detergent and other toxins were locked in the garage. (continued on LIC 809-C) (continued from LIC 809) Garage - The garage was attached to the house and was observed to be locked during visit. The garage is also being used as frozen food, PPE, cleaning agents, laundry detergents and other toxins and old equipment storage. Resident Rooms: There are five (5) resident rooms which were furnished with a bed, linens, night stand, lamp and chair. The rooms were properly furnished and observed to be neat and clean. Bathrooms: There are three bathrooms in the facility. The bathrooms contained hand soap, paper towels, grab bars, and slip resistant mats. LPA observed the clean linens were located in a cabinet within the staff bathroom. Water Temperature: was tested and measured at a range of 108.2°F to 111.6°F. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is a shaded area with comfortable seating in backyard. Client records: Client records are reviewed. Client records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff record. Staff records appeared to be complete and updated. Disaster drill was last conducted on 02/06/26 . Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Mar 7, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the caregiver. The Licensee, Marlen Lopez, was called. The Licensee had previously informed LPA the facility now has one resident. LPA Spaeth stated the purpose of the visit was to tour the facility and review the resident's file. LPA and the caregiver toured the facility at 2:35 pm to 2:54 pm. Kitchen - LPA observed a two day supply of perishable food and a seven day supply of non-perishable food. LPA Spaeth tested the water temperature at 3:00 pm which was 110.4 Degrees F. The knives and cleaning solutions were locked in a kitchen cabinet. Resident Room - LPA observed the resident was resting comfortably in their room. Bathrooms - LPA Spaeth observed the bathrooms contained slip resistant mat, hand soap, grab bars, and a trash can. Resident File/Medications - LPA reviewed the resident file at 3:10 pm until 3:45 pm. There are no issues regarding the resident's file and the resident's medications. Smoke Detectors - The smoke detector was tested at 3:48 pm and was operable. There are no deficiencies to report at this time. Exit interview conducted and a copy of the report was given.the state’s words, verbatim · CDSS document, Jun 11, 2025

Type of visit: Prelicensing

On 2/28/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced pre-licensing visit to this facility and met with the Applicant, Christine Bwogi and the Administrator Marlen Lopez. This is a new application. A fire clearance dated 11/27/2024 was received for six (6) non-ambulatory residents. Bedrooms 1, 2, 3, and 5 are designated to house one (1) non-ambulatory resident. Bedroom four is designated to house two (2) non-ambulatory residents. The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Component III was conducted with the applicant and administrator from 9:40 am until 11:15 am. Today’s site visit consisted of LPA touring the physical plant inside and outside from 11:20 am until 11:45 am. LPA Spaeth observed the following: Office – The office contained a desk and a locked file cabinet. The staff and resident files will be locked in the cabinet. Living Room– the living room contained comfortable seating. Family room – The room contained comfortable seating. Continued 809-C Kitchen/Dining Room - The knives were locked in a kitchen cabinet. The facility contained a two-day supply of perishable food and a seven day supply of non-perishable food. A fire extinguisher is located in the kitchen area. The dining area contained a dining room table and chairs. Laundry Room – A washer and dryer are located in the room. The resident medications will be locked in a cabinet. The laundry soap, first aid kit and cleaning solutions are locked in a cabinet. Backyard - The backyard has a flower garden surrounded by comfortable seating. A shaded seating area is also available for residents. Also, there is a designated area for residents to plant their own garden. Water Temperature - The water temperature was tested at 11:30 am and was 105.9 degrees F. Bathrooms- The bathrooms contained hand soap, slip resistant mats, paper towels, grab bars and a trash can. Bedrooms – The bedrooms contained bed, linens, night stand, chest of drawers, a chair, and a closet. Hallway Closet - The hallway closet contained linens. Garage – the garage was locked and is designated as a staff break room. The smoke/carbon monoxide detectors were tested at 11:45 am and were operable. The facility was clean and appears to be in good repair. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.the state’s words, verbatim · CDSS document, Feb 28, 2025

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Christine Bwogi, Applicant Marlen Lopez, Administrator Interview Method: Virtual interview (Microsoft Teams) On January 22, 2025 at 1:00 PM, Applicant and Administrator participated in COMP II. Identification of the Applicant and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB analyst confirmed Applicant and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant and Administrator. Report sent via email and request to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Jan 22, 2025