Ethel's Guest Home

Allegation investigated: Staff did not prevent resident from developing a pressure injury

On 05/13/26 Licensing Program Analyst (LPA) Mario Leon delivered findings regarding the allegation above. California Department of Social Services (CDSS) was met by staff one, Ethel Monterroso (S1) and the purpose of the visit was explained. The investigation consisted of the following: On 10/29/25 CDSS toured the facility, along with S1, and requested a resident roster (dated: 09/22/25) and staff roster (dated:10/29/25). LPA collected two resident's (R1 & R2) paperwork, listed as follows: Admissions agreements (dated: 08/01/24 & 01/14/25), medical assessments (dated: 08/07/23 & 01/15/24), emergency identification forms (dated: 08/01/23 & 01/14/24), appraisal needs and services (dated: 08/01/23 & 01/13/25) and medical consent forms (dated: 08/01/23 & 01/13/25). On 05/12/26 CDSS collected further records from the hospice services of R1, death certificate of R1 and CDSS interviewed three (3) staff (S1-S3), one (1) family witness (W1) and one (1) hospice nurse (W2) and two (2) out of five (5) residents (R2 & R3). Residents four through five were not available (R4-R5) for interview due to medical condition. Report continues, please see LIC9099-C Unsubstantiated The investigation revealed the following: Regarding the allegation “Staff did not prevent resident from developing a pressure injury”, it is being alleged that a resident (R1) was admitted on 10/25/25, with a stage 3 or greater Sacral Gluteal wound with necrotic tissue due to staff neglect. Record reviews revealed that on 10/29/25 R1 was being provided hospice services by Loyalty Hospice Services, Inc. On 11/01/25 R1 was admitted to Los Palos Post-Acute Care Center and was receiving Physical Therapy and Occupational Therapy and that R1 responded well to skilled services. On 05/12/25 LPA observed staff responding to requests from five (5) residents and two (2) family members visiting with their responsible person(s). Interviews revealed that two (2) out of three (3) staff were unfamiliar with R1, while one (1) out of three (3) staff disagreed with the allegation. One (1) family witness (W1) and one (1) hospice nurse (W2), along with two (2) out of two (2) residents, disagreed with the allegation. Based on observation, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Ethel Monterroso - Licensee (S1), and a copy of this report has been provided.the state’s words, verbatim · CDSS document, May 15, 2026 · control 11-AS-20251028151606

Type of visit: Required - 1 Year

On 08/28/2025 at 11:00 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Ethel’s Guest Home Facility. LPA Calderon was allowed entry into the facility by Administrator Ethel Monterroso. The facility is a license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) individuals, of which maybe five (5) non-ambulatory, and one (1) bedridden. There are currently four (4) Clients residing in the facility. LPA Calderon explained to Administrator Ethel Monterros the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Four (4) client service records, four (4) client medication records, two (2) staff records, and inspected the inside facility and outside grounds. The facility’s last fire drill was conducted on 07/10/2025. The one-story residential home consists of four (4) client bedrooms, three (3) client bathrooms, living room, family room, dining room, kitchen, staff room, office area, garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored on the premises. The kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is found in the garage and kitchen area. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of client’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 106 degrees Fahrenheit. Bathroom #2 hot water temperature properly measured at 107 degrees Fahrenheit. Bathroom #3 hot water temperature properly measured at 108 degrees Fahrenheit. Kitchen hot water temperature is properly measured at 108 degrees Fahrenheit. Facility one (1), Carbon Monoxide and seven (7) Smoke Detectors, hard-wired and connected, were tested and are working properly. The facility two (2) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knives are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked storage cabinet. Facility two (2) first aid kit is fully stocked with manuals was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to clients. Four (4) client files were reviewed and found to be complete. LPA Calderon reviewed four (4) resident medications, and they were all found to be administered according to doctor's orders. Two (2) staff files were checked, and they have the required documents. LPA Calderon noted the Administrator Ethel Jane Monterroso Certification # 7023722740 expiration date of 10/28/2026 was valid at time of inspection. Commercial General Liability Policy #001580010 policy period from 09/14/2024 to 09/14/2025 underwritten by James River Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. All the required documents are posted in the facility in a clearly visible area. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Ethel Monterroso.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Prelicensing

On 08/01/24, Licensing Program Analysts (LPAs) Ernand Dabuet and Zina Brown conducted announced visit to this home. LPA was greeted by applicant Ethel Monterroso and explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 04/24/24 in the initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) individuals, of which maybe five (5) non-ambulatory, and one (1) bedridden. Structure: The home is a four (4) bedroom, two (2) bathroom, one story home with a two (2) car garage situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. The living room did include a fireplace. The living area included seating. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. Bedrooms Residents: The facility had four (4) bedrooms for residents. There are four (4) bedrooms for non-ambulatory residents and (1) of the bedrooms specific for the bedridden. All rooms include a twin-size bed, one (1) chair, one (1) night stand, and one (1) table lamp. All bedrooms are equipped with a ceiling light. All rooms had a dresser, which complies with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. The room also included wall night lights. Evaluation Report Continues Bedrooms Staff: There is no bedroom designated for live-in staff. Bathrooms: The home has two (2) bathrooms. One (1) staff bathroom. Bathrooms are accessible in all rooms. All bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats. Linens & Hygiene Supplies: Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the hall closet inside the bedrooms. Emergency Phone Numbers, Exit Plan & Menu: Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There are two (2) fire extinguishers located in the kitchen and entry way. A telephone line is available in the kitchen and living room. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant as an approved Infection Control Plan on file. Food Service: Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked kitchen drawer. Food supply is adequately stored in kitchen cabinets and consists of the can goods. The kitchen counters also had small appliances. Smoke Detectors: Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors in all four (4) bedrooms and hallways. Carbon monoxide is combined with smoke detectors. Toxins: All toxins are locked and stored under the kitchen sink cabinet. Evaluation Report Continues Appliances: Stove burners, oven, microwave, washer, and dryer are working. The kitchen counters also had small appliances which includes a, blender, toaster, and coffee maker. There is one (1) refrigerator in the home. The refrigerator measured a temperature of at least 40 degrees Fahrenheit for appropriate food storage. The home is equipped with with central heating and air. Water Temperature: The water temperature is 119.4 degrees throughout the kitchen and bathrooms. Medications, First-Aid Kit & Book: A first aid kit is stored in the kitchen cabinet which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in the same kitchen cabinet locked in the kitchen area and inaccessible to residents. Resident & Staff Files: The applicant is not handling the cash resources for residents. Records of staff and residents are stored in a locked kitchen cabinet. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines, and other recreational materials for the resident's use all stored in the living room. Pool/Jacuzzi & Pets: There are no pets, jacuzzi, or pool in the fenced area. Evaluation Report Continues Fire clearance: A Fire Clearance inspection was conducted on 12/14/23 approved for a capacity for five (5) non-ambulatory, one (0) for ambulatory, and one (1) for bedridden. Component III: LPA Brown conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III PowerPoint. LPAs Dabuet and Brown observed the following corrections: Bathroom #1 screen need to be replaced or repaired. Kitchen Dishwasher is non-operable.- Corrected 08/24/24 Range stove hood requires deep cleaning. - Corrected 08/04/24 Staff Bed need to be removed from the garage. - Corrected 08/04/24 Soffit light over the kitchen sink need to be cleaned. - Corrected 08/04/24 An exit interview was conducted, and a copy of this report has been furnished to the applicant Ethel Monterroso. LPA Dabuet will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application. END OF REPORTthe state’s words, verbatim · CDSS document, Aug 1, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 6 COMP II Participant: Ethel Monterroso, Managing Member/Administrator Interview Method: Telephone interview On 7/16/24, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/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 readinessthe state’s words, verbatim · CDSS document, Jul 16, 2024