Casa Del Sur

Type of visit: Required - 1 Year

On September 12, 2026, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced 1 Year Required visit. LPA met with licensee/administrator Evangeline Agatep and explained the purpose of today’s visit. The facility is licensed to operate for six (6) residents (2) may be ambulatory and (4) non-ambulatory elder adults 60 and above. The facility is approved for (2) hospice residents. Currently, the facility has no residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, one (1) staff room, a living area, a dining area, a kitchen, an outside covered patio area, and a garage used for storage. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 110.2 degree F. A comfortable temperature of 84 degree F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. The last fire and earthquake drill was conducted in September 6, 2026. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The facility is current on Community Care Licensing annual dues. The facility has a current liability insurance effective: 09/02/26 through 09/02/27 with policy #5043. The facility has a current administrator certificate for Evangeline Agatep #0740 valid 11/09/2024 - 11/08/2026. An audit of residents #1-#5 (R1-R5) service files and staff #1-#5 (S1-S5) personnel files revealed to be complete. Deficiency; During service file audit Resident #1 did not have a TB examination test results. An exit interview conducted with Evangeline Agatep and a copy of report was provided. Note: Due to technical difficulties, LPA was unable to generate an electronic inspection tool and instead used a printable/PDF version.the state’s words, verbatim · CDSS document, Sep 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a)(1) · Plan of correction due date: Sep 26, 2026

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment...(1) A physical examination..(A) Communicable tuberculosis. This requirement is not met as evidence by: Based on record review,Resident 1 did not have TB examination with results when admitted. This violation possesses a potential Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 12, 2026

Plan of correction: Licensee must comply with Title 22 Section 87456 and ensure that all residents when admitted have TB examination with results. Proof of correction, must be submitted by the due date of 09/26/26 to 424-544-1016. en

Type of visit: Required - 1 Year

On July 23, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with licensee/administrator Evangeline Agatep and explained the purpose of today’s visit. The facility is licensed to operate for six (6) residents (2) may be ambulatory and (4) non-ambulatory elder adults 60 and above. The facility is approved for (2) hospice residents. Currently, the facility has no residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (2) common bathrooms, one (1) staff room, a living area, a dining area, a kitchen, an outside covered patio area, and a garage used for storage. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 105.7 degree F. A comfortable temperature of 80 degree F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. The last fire drill was conducted in June 5, 2025. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The facility is current on Community Care Licensing annual dues. The facility has a current liability insurance effective: 09/02/24 through 09/02/25 with policy #001147504-01. An audit of residents #1-#5 (R1-R5) service files and staff #1-#5 (S1-S5) personnel files revealed to be complete. No Deficiencies cited during this inspection visit. An exit interview conducted with Evangeline Agatep and a copy of report was provided.the state’s words, verbatim · CDSS document, Jul 23, 2025

Type of visit: Required - 1 Year

On 06/29/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with licensee/administrator Evangeline Agatep and explained the purpose of today’s visit. The facility is licensed to operate for six (6) residents (2) may be ambulatory and (4) non-ambulatory elder adults 60 and above. The facility is approved for (2) hospice residents. Currently, the facility has (2) residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (2) common bathrooms, one (1) staff room, a living area, a dining area, a kitchen, an outside covered patio area, and a garage used for storage. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 110.7 degree F. A comfortable temperature of 80 degree F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. Evaluation Report Continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. The facility is current on Community Care Licensing annual dues. The facility has current CCLD administrator certificate for Evangeline Agatep #6021587740 Exp. 11/08/24. The facility has a current liability insurance effective: 09/02/23 through 09/02/24. An audit of residents #1-#5 (R1-R5) service files and staff #1-#3 (S1-S3) personnel files revealed to be complete. Interviews were conducted with (1) resident and (1) staff. Two (2) residents were hospitalized were not able to be interviewed. No Deficiencies cited during this inspection visit. An exit interview conducted with Evangeline Agatep and a copy of report was provided.the state’s words, verbatim · CDSS document, Jun 29, 2024