Angel's Haven II

Type of visit: Case Management - Other

On 08/26/2026, at 2:45PM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to correct the LIC809-D for clarification(Annual). The amendment was signed by Oscar and a copy was left at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Required - 1 Year

On 07/20/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct the annual inspection. Upon arrival LPA met with support staff Floridalma Lechuga and Vicenta Mendoza who were explained the purpose of the visit. The facility is licensed to serve six (6) residents ages 60 and over. Facility has been approved for six (6) Non-Ambulatory residents. The facility has been approved to retain (6) hospice residents. The fee’s are current. The facility is a single-story home located in a residential neighborhood. It consists of (3) bedrooms, (2) full bathrooms, living room, dining room, kitchen, shaded back yard, front yard, laundry room and garage. At 2:15 PM, LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings which all appeared to be current. LPA reviewed four (4) residents files for admission agreements, updated physician reports, and needs and services plans which all appeared to be current. However, R4 is bedridden based on their physicians’ report dated 3/19/2026 and LPA observations. The facility is not licensed to care for bedridden residents nor is there an approved fire clearance. At 3:30 PM, LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene items were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The bathrooms appeared to be clean with required handrails and non-slip mat, toilets and wash basin appeared to also be in good condition and operable. The water temperature ranged from 105°F to 120. °F, The kitchen was inspected, and there was a 5-day supply of perishable and a 7day supply of non-perishable food items which were adequately maintained/stored. The fire extinguishers were fully charged; carbon monoxide detectors and smoke detectors were fully charged and operable. The last Fire/Disaster drills were conducted on June 3,2026. Based on the observations and records reviewed made during today’s visit a deficiency was cited for caring for a bedridden resident without proper fire clearance. An exit interview was conducted, and this report LIC809, 809-C and 809-D was discussed and provided to Oscar Lechuga- Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 20, 2026

Type of visit: Required - 1 Year

On 06/19/2025, Licensing Program Analyst (LPA) Yolanda Rosser arrived at facility to conduct an unannounced annual required using the CARE Inspection Tool. LPA Rosser met with Administrator, Oscar Lechuga . LPA Rosser explained the purpose of today’s visit. The facility is licensed to serve six (6) residents ages 60 and over. Facility has been approved for six (6) Non-Ambulatory residents. Approved to retain one (01) Hospice Resident. Facility has an approved hospice waiver for (6). Fees are current. The facility is a single-story structure located in a residential neighborhood. It consists of (3) bedrooms, (2) full bathrooms, living room, dining room, kitchen, shaded back yard, front yard, laundry room and attached 2 car garage. LPA Rosser toured the physical plant with Administrator, Oscar Lechuga. There were no bodies of water or obstructions on the premises. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected (2) bathrooms. Smoke and carbon monoxide are all operable conditions. The water temperature ranged from 113.5F° – 115.3F°. The room temperature ranged from 74°F - 75.0. LPA observed several games and activities, puzzles, card games, board games for the residents. CONTINUED ON LIC 809 C PAGE LPA Rosser observed the facility to be clean and sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Cleaning supplies, toxins, and sharps objects were stored and not accessible to residents in care. The kitchen was inspected and there is an abundance of perishable and non-perishable food available and maintained properly. All fire extinguishers were charged and were operable. The facility has regular fire drills annually. LPA reviewed the disaster plan which is update. The home is well maintained and organized. The bedrooms are clean and sanitary and lots of natural lighting and drapes. A review of (4) residents' files and (4) staff personnel files were reviewed and found to be in order. LPA reviewed (4) Medication Administration Records (MAR) no discrepancies were found. LPA observed the facility's infection control practices. All mandated inspection control posters were posted throughout the facility. LPA observed no deficiencies on todays inspection. Exit interview was conducted and a copy of this report was provided to Administrator, Oscar Lechuga.the state’s words, verbatim · CDSS document, Jun 19, 2025

Allegation investigated: Staff neglect led to resident sustaining pressure injury. Resident sustained unexplained injuries. Staff inappropriately restrained resident. Staff did not treat resident with dignity and respect. Staff did not provide resident with privacy. Staff did not provide a comfortable temperature for residents.

On 07/13/24, Licensing Program Analyst (LPA) Ernand Dabuet made a subsequent unannounced visit to this facility and was greeted by the staff Vicenta Mendoza (S1). LPA explained the purpose for today’s visit is to gather information for the allegations mentioned above and deliver findings. The investigation consisted of the following: An initial 10-Day visit was conducted on 07/03/24 a subsequent visit on 07/13/24 by LPA DAbuet. (LPA) requested copies of client and staff roster. (R1's) Admission Agreement (dated: 01/05/24), Physicians Report (dated: 10/25/23), Preplacement Appraisal LIC 603 (dated: 01/05/24), Resident Appraisal LIC 603A (dated: 01/26/24) Appraisal/Needs Services Plan LIC625 (dated: 01/26/24), Client Weight Record (dated: 01/01/24 - 06/01/24) and other pertinent documents associated with this complaint. Interview conducted with residents #1-#4 (R1-R11), and Administrator #1 (A1) staff #1-#2 (S1-S3). An iinspection of the facility was conducted. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: ALLEGATION #1: Staff neglect led to resident sustaining pressure injury. ALLEGATION #2: Resident sustained unexplained injuries. The details of the complaint alleged due to staff neglect resident #1 (R1) sustained pressure injuries. The complainant observed on 06/23/24 a bruise on the chest and right arm (R1). Several weeks back the complainant also observed a bed sore on (R1’s) buttock area. The complainant reported the staff were unable to explain the reason for the bruises and bed sore when inquired. The complainant was not available to provide further details on this allegation. Investigation revealed (R1) was admitted to Angel’s Haven II on 01/05/24 in accordance with the Admissions Agreement (dated: 01/05/24). (R1) received hospice care from Divine Hospice Services, Inc., effective 01/07/24. On 07/03/24, between 09:00 am – 10:15 am, the Department interviewed (4) out of (4) residents #1-#4 who denied having sustained any bruises or pressure injuries while in care. (R1) claimed to have no bruises on the chest and arms nor a bed sore on (R1’s) buttocks area. (R1-R4) are complimentary of staff and the care and assistance they all receive from each of the staff. On 07/03/24, between 09:30 am – 10:45 am, the Department interviewed (3) out of (3) administrator #1(A1) and staff #1-#2 (S1-S2) claimed this allegation was false. (A1 and S1-S2) stated no residents in care have sustained any bruising or pressure injuries while in care. (A1 and S1-S2) claimed that (R1) is under hospice care with Divine Hospice Services, Inc., and it is under medical professionals with a registered nurse (RN) and licensed vocational nurse (LVN) twice a week. (A1-S1) claimed the facility staff was only responsible for (R1)’s non-medical care since the facility is a non-medical care facility. (A1 and S1-S2) pointed out that although they are not trained medical professionals, the facility staff is capable of caring for and supervising residents. (R1) is not bedridden and can reposition in bed, according to (A1-S1). On 07/03/24, between 02:28 pm – 02:45 pm, the Department interviewed (5) out of (5) witnesses #1 - #5 (W1-W5) denied residents ever sustained bruises or pressure injuries while in care. (W1) a registered nurse (RN) from Divine Hospices Services confirmed that (R1) has been under hospice care since 01/07/24 and that this accusation is false. (Evaluation Report continues LIC 9099-C) (W1) stated if had any type of pressure injuries or bruising (R1). (W1) claimed a wound care specialist would have been required, and a wound care plan would have been established. (W1) commented that (R1) is under-prescribed medications that have side effects that can cause unusual bleeding or bruising. On 07/03/24, the Department examined (R1) and did not observe any bruises or bed sores. A review of the hospice medication list (dated: 01/05/24) revealed (R1) is prescribed nine (9) medications. Seven (7) out of (9) prescribed medications have side effects that can cause unusual bleeding or bruising in accordance to the National Institute of Health (ref: NIH). Based on the information gathered, there is no evidence to support the allegation mentioned above. ALLEGATION #3: Staff inappropriately restrained resident. The complainant alleged resident #1 (R1) was improperly restrained while in care. The complainant reported the facility staff is improperly restraining (R1) in a wheelchair or chair, attaching an alarm cord to (R1’s) clothes so that whenever (R1) moves, the alarm goes off. According to the complainant, the staff has informed (R1) that (R1) is not allowed to leave the chair. The complainant did not provide further details on this matter. On 07/03/24, between 09:00 am – 10:15 am, the Department interviewed (4) out of (4) residents #1-#4 (R1-R4) indicated they were not restrained by any devices that would prevent their mobility. (R1) claimed not to feel limited in mobility even having a magnet alarm attached to (R1’s) clothing. On 07/03/24, between 09:30 am – 10:45 am, the Department interviewed (3) out of (3) administrator #1(A1) and staff #1-#2 (S1-S2) claimed this allegation was incorrect. (A1 and S1) communicated the residents are not restrained from mobility. (R1) is a fall risk. The fall plan approved by hospice included a magnet alarm with a cord attached to (R1’s) clothing that will sound off when (R1) is seated and attempts to rise off only while in a recliner and it is not used while in a wheelchair. (A1-S1) reported that there are no vests, ties, or belts attached to this system to restrain (R1’s) mobility. Furthermore, when the monitor system is activated, (R1) is not limited from mobility as it is only used to summon a staff when (R1) stands pulls away to trigger the alarm and is redirected. (Evaluation Report continues LIC 9099-C) On 07/03/24, between 02:28 pm – 02:45 pm, the Department interviewed (5) out of (5) witnesses #1 - #5 (W1-W5) and claimed no residents are restrained while in care. (W1) a registered nurse (RN) from Divine Hospices Services confirmed that (R1) is a fall risk and part of the fall management is to have a magnet alarm on (R1) as an added assistance for monitoring (R1) to prevent further life-threatening falls. A review of (R1’s) Physician Report LIC 602A (dated: 10/23/23) and Appraisal/Need Services Plan (dated: 01/20/24) indicated (R1) is an ambulatory, fall risk and requires assistance and supervision. Divine Hospice Services records (dated: 01/05/24) outlined (R1) is a fall risk and a plan is included. Based on the information gathered, there is no evidence to corroborate the allegation mentioned above. ALLEGATION #4: Staff did not treat resident with dignity and respect. ALLEGATION #5: Staff did not provide resident with privacy. It is alleged the facility staff did not treat resident # 1 (R1) with dignity and respect nor provide privacy during visits. The complainant reported the staff are preventing (R1) from receiving phone calls and privacy during visitations. The complainant did not offer further details on these allegations. On 07/03/24, between 09:00 am – 10:15 am, the Department interviewed (4) out of (4) residents #1-#4 (R1-R4) communicated that the facility treated them with dignity and respect. (R1-R4) expressed the facility staff treated them with care and compassion and had no issues or concerns with privacy during appointment visits. On 07/03/24, between 09:30 am – 10:45 am, the Department interviewed (3) out of (3) administrator #1(A1) and staff #1-#2 (S1-S2) stated this is untrue. (A1 and S1-S2) reported that all residents are given privacy during appointment visits from family members or health agencies. (A1) stated the residents can have their private visits indoors or outdoors, and incoming calls are not being monitored or refused. On 07/03/24, between 02:28 pm – 02:45 pm, the Department interviewed (5) out of (5) witnesses #1 - #5 (W1-W5) and claimed to have no issue with how the residents were treated. (W2) power of attorney for (R1) is complimentary of the staff and stated that (R1’s) health has improved since assisted with care and supervision at this facility. (Evaluation Report continues LIC 9099-C) (W2) expressed that staff were respectful of their privacy during visits and observed staff communicate with residents with empathy and kindness. (W1-W5) claimed they have not been denied access to residents with phone calls or visits. Based on the information gathered, there is no evidence to support the allegation mentioned above. ALLEGATION: #6: Staff did not provide a comfortable temperature for residents. It is alleged by the complainant that on 06/23/2024, there was no air conditioning in the facility, and the doors and windows were closed. The complainant did not offer additional detailed information on this matter. The Department conducted a health and safety inspection on 07/03/24 at 9:00 am – 12:30 pm and found the temperature in the facility to be within Title 22 regulations. The facility thermostat read 76.0 degrees F. Portable free-standing fans were available in all the resident’s rooms and a Vagkri portable air conditioner unit was in the living room and dining room area. The room temperature in bedroom #1 is 78.0 degrees F; bedroom #2 is 78.0 degrees F; bedroom #3 is 77.0 degrees F. The kitchen, dining, and living rooms had temperatures of 77.0 - 78.0 degrees F. The Department observed windows and sliding doors, the front door was not closed, and an outdoor breeze was filtered through the rooms. On 07/03/24, between 09:00 am – 10:15 am, the Department interviewed (4) out of (4) residents #1-#4 (R1-R4) claimed that the facility provided a comfortable temperature for residents in care. (R2 and R4) long-term residents since 2021 have never felt uncomfortable with the temperature in the facility as there are heating and cooling systems equipped in all the rooms. On 07/03/24, between 09:30 am – 10:45 am, the Department interviewed (3) out of (3) administrator #1(A1) and staff #1-#2 (S1-S2) stated this accusation was false. (A1) described that the home is not equipped with built-in air conditioning and only equipped with heating. (A1 and S1-S2) reported during summer months when the temperature rises, they ensure the fans are operating and there is enough circulation throughout the facility. Moreover, the staff monitors the residents for liquids and body temperature. On 07/03/24, between 02:28 pm – 02:45 pm, the Department interviewed (5) out of (5) witnesses #1 - #5 (W1-W5) claimed to have no issues with the temperature in the facility. (W1-W5) reported that temperature has always been comfortable during visits at the facility and did not observe any residents neglected in care due to uncomfortable temperature. (Evaluation Report continues LIC 9099-C) According to public records, this facility is a single-family home built in 1962 with (3) bedrooms and (2) baths and 1,334 square feet of space. It has heating and no cooling which verified the statement remarked by (A1). Based on the information gathered, there is no evidence to corroborate the allegation mentioned above. Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Vicenta Mendoza, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Jul 13, 2024 · control 11-AS-20240624132504

Allegation investigated: Facility staff not permitting resident to have visitors without prior notice Facility staff not providing adequate meal service to resident Facility staff not assisting resident with ambulating as needed

On 07/10/2024 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Angel’s Haven 2 and was greeted by Administrator Oscar Lechuga A1. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: LPA Calderon interviewed Administrator (A1), Staff (S1-S2), interview resident (R1-R4) and interviewed Witness (W1). On 07/10/2024 LPA Calderon obtained and reviewed the following: Admission agreement (date 01/05/2024), preplacement appraisal (date 01/05/2024), Needs and service plan (date 01/05/2024), Physician report (date 10/25/2023), Client weight record (date 01/06/2024 to 06/01/2024), Divine Hospice Services (date 01/08/2024), facility meal plan for R1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Facility staff not permitting resident to have visitors without prior notice. It is being alleged that facility staff did not permit resident to have a visitor without prior notice. The interviews indicate the following: A1 indicates that all resident family are welcome to visit anytime they want between the hours of 1pm to 8pm. A1 indicates that R1 family member was not asked to give notice prior to visiting R1. A1 indicates that staff would not refuse to allow residents from visiting. S1-S2 indicate that R1 family could visit between the hours of 1pm to 8pm weekly. S1-S2 indicate that staff did not prevent R1 family from visiting. 2 out of 4 residents indicate that their family could visit when they wanted, and staff would not prevent any family member from visiting a resident. 2 out of 4 residents were non-verbal due to health issues and could not be interviewed. W1 indicates that R1 family could visit any time they wanted, and staff would not prevent any visit. W1 indicates that facility staff did not advise that R1 family member had to ask for notice to visit prior to arriving at the facility. Reviewed Admission Agreement (date 01/05/2024) for R1. Admission agreement indicates that resident’s family can visit between 1pm and 8pm. There is no mention of resident family members having to call or give prior notice. Regarding Allegation #2: Facility staff not providing adequate meal services to resident. It is being alleged that facility staff did not provide adequate food to resident. The interviews indicate the following: A1 indicates that every resident is given 3 meals and 3 snacks per day. A1 indicates that if a resident is hungry all the residents must do is ask for food and staff would provide extra food to eat. A1 indicates that no resident goes hungry. 2 out of 2 staff indicate that they provide 3 meals and 3 snacks per day and no resident goes hungry. 2 out of 4 residents indicate that staff serves them 3 meals and 3 snacks per day. 2 out of 4 residents indicate that staff serves them enough food and they do not go hungry. 2 out of 4 residents were non-verbal due to health issues and could not be interviewed. W1 indicates that R1 has never advised W1 that staff has not served R1 enough food to eat. W1 indicates that R1 has gained weight and R1 health is doing better. LPA Calderon reviewed the weekly meal plan and noted different meals per day and that 3 meals and 3 snacks are served. LPA Calderon toured the kitchen area and noted enough food to feed 4 residents and 3 staff for more than 7 days. LPA Calderon noted snacks were served to residents and lunch was served. Reviewed R1 client weight record (date 01/06/2024 to 06/01/2024), LPA Calderon noted that R1 gained eight pounds (LBS) in the six months R1 has been living at the facility. Regarding Allegation #3: Facility staff not assisting resident with ambulating as needed. It is being alleged that facility staff did not move resident as needed. The interviews indicate the following: A1 indicates that R1 moved into the facility under hospice care. A1 indicates that R1 was non ambulatory and has cognitive issues. A1 indicates due to health issues R1 could not be moved without help. 2 out of 2 staff indicate that R1 was moved but could not walk. 2 out of 4 staff indicate that R1 was under hospice care and could not move as other residents. 2 out of 4 residents indicate that with help staff takes them for walks weekly. 2 out of 4 residents were non-verbal due to health issues and could not be interviewed. W1 indicates that when R1 moved into the facility R1 was on hospice care due to health issues and could not walk. W1 indicates that R1 cannot walk, and staff helps R1 move from the bed to the chair. W1 indicates that R1 health has improved since living at the facility for 6 months. Reviewed Physician Report (date 10/25/2023) for R1. Physician Report indicates that R1 was ambulatory and needed help with moving. Reviewed Divine Hospice Services (date 01/08/2024) for R1. Hospice services noted health issues for R1. Based on interviews, observations and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Facility staff not permitting resident to have visitors without prior notice” “facility staff not providing adequate meal service to resident”, “facility staff not assisting resident with ambulating as needed” is found to be UNSUBSTANTIATED. A face-to-face meeting was conducted with Administrator Oscar Lechuga, and a hard copy was provided.the state’s words, verbatim · CDSS document, Jul 10, 2024 · control 11-AS-20240701105401

Type of visit: Required - 1 Year

On 5/10/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required using the CARE Inspection Tool. LPA met with Oscar Lechuga /Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) elderly adults ages 60 and above of which (6) can be non-ambulatory. Facility has an approved hospice waiver for (6). The facility is a single-story structure located in a residential neighborhood. It consists of (3) bedrooms, (2) full bathrooms, living room, dining room, kitchen, shaded back yard, front yard, laundry room and attached 2 car garage. LPA Iniguez toured the physical plant with Administrator. There were no bodies of water or obstructions on the premises. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected (3) rooms and (2) bathrooms. Smoke and carbon monoxide are all operable conditions. The water temperature ranged from 114.5F° – 116.2F°. The room temperature ranged from 76F° – 78F°. Evaluation Report continues on LIC 809-C LPA Iniguez observed the facility to be clean and sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Cleaning supplies, toxins, and sharps objects were stored and not accessible to residents in care. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. The last Fire/Disaster Drills were conducted on 4/5/24. A review of (3) residents' service files and (3) staff personnel files were maintained in order. LPA reviewed (3) Medication Administration Records (MARs) no discrepancies were found. LPA observed the facility's infection control practices. All mandated inspection control posters were posted throughout the facility. Copy of liability insurance will be email to LPA. Facility Annual Fess not current as 5/31/24. LPA provided PIN: 823479 to licensee. Administrator pay fees while LPA was at the facility. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Oscar Lechuga /Administrator.the state’s words, verbatim · CDSS document, May 10, 2024