Augustine Family Elder Care

Type of visit: Prelicensing

On 10/03/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a scheduled Pre-Licensing Visit. LPA met with Licensee Andrea Augustine, and the purpose of today’s visit was explained. LPA was granted entry. An application was submitted to CCLD on 07/16/2025. The facility is a Residential Care Facility for the Elderly that will serve six (6) residents over the age of 60. The facility has an approved Fire Clearance for five (5) non-ambulatory and one (1) bedridden in bedroom #1. The facility has a hospice waiver for six (6) residents. Physical Plant/Structure The facility is a single-story structure in a residential neighborhood. It consists of four (4) bedrooms, three (3) bathrooms, kitchen, dining area, living area, laundry room, front and backyard, and attached garage. The backyard has a shaded patio with a table and chairs. All walkways around the facility were observed clean, clear, and free of debris, obstruction, and hazards. LPA observed a pool in the back yard that has a fence around it that meet Title 22 regulations and is inaccessible to residents. All windows, screens, and blinds were observed to be in good repair. LPA observed a screened fireplace that is inaccessible to residents. Bedrooms LPA inspected resident bedrooms. LPA observed the resident rooms were clean and in good repair. LPA observed the bedrooms have the required furniture including bed(s), dresser(s), nightstand(s) with lamp(s), chair(s), and ample storage space for resident’s personal belongings. The beds have the required linens including a mattress cover, fitted sheets, top sheet, blanket, comforter, and pillows. Bedrooms were observed with ample lighting. LPA observed an ample supply of linens in a closet in the hallway. Bathroom LPA inspected all bathrooms and observed them to be operable and within Title 22 regulations. LPA observed all showers were clean and free of mildew and mold. All safety handrails are securely fastened. LPA observed nonskid mats and shower chairs available in the showers. LPA observed an ample supply of toiletries, towels, and wash clothes for residents. The water temperature in the bathrooms measured 112.5-degrees, 112.3-degrees, and 113.2-degrees Fahrenheit. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. All appliances were observed operational and in good repair. LPA observed an ample supply of cookware, dishware, and cutlery. LPA observed a 2-day supply of perishable foods, and 7-day supply of nonperishable foods properly labeled and stored. The water temperature measured 114.3-degrees Fahrenheit. LPA observed knives and sharps secured in a locked in a drawer. All cleaning supplies were observed secured in the locked cabinet under the sink. Common Areas During the facility inspection, LPA observed in the living area there are recliners to accommodate residents. LPA observed an ample supply of games, activities, and reading material available. The dining room has a large table with chairs to accommodate residents. LPA observed the facility to be appropriately furnished at the time of visit. All rooms were observed clean and in good repair. LPA observed all rooms and hallways have ample lighting. The hallways have night lights. All walkways and hallways in the facility were observed clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature. Files LPA observed a cabinet in the laundry area where the resident files and staff files will be locked and inaccessible to residents. LPA observed the Licensee has a valid Administrator Certificate active till 09/19/2026. LPA received and reviewed a copy of the facility’s Emergency and Disaster Plan For Residential Care Facilities for the Elderly (LIC610E). LPA observed a copy of the LIC610E posted in the facility in a hallway. LPA received and reviewed a copy of the facility’s Infection Control Plan. LPA observed a copy of the facility’s Infection Control Plan posted in the hallway. LPA observed all required signs and information posted inside the facility. Medications LPA observed a cabinet in the kitchen where Centrally Stored Medications will be secured. LPA observed and tested the lock on the medication cabinet. Medications will be documented on a Medication Administration Record (MAR). Safety LPA observed two (2) fully charged fire extinguisher last serviced on 10/28/2024. LPA observed and tested all smoke detectors and carbon monoxide detectors and found them to be operable. All doors have an alarm that chimes when a door exiting the facility is opened. The facility has a working landline telephone. LPA observed a First Aid kit with the required items and a current manual secured in the medication cabinet. LPA observed a supply of emergency food and water. LPA observed a supply of emergency lighting and batteries. There are no firearms or ammunition on the premises. Infection Control Upon entry, LPA observed a sanitizing station that consisted of a Visitor Sing in log, hand sanitizer, thermometer, and masks available. LPA observed required Infection Control signs posted in the facility. LPA observed an ample supply of cleaning products secured in locked cabinets. Licensee and LPA reviewed and discussed Component III. LPA did not observe any advisory deficiencies or violations. An exit interview was conducted with Licensee, Andrea Augustine, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 3, 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: Andrea Augustine, Applicant/Administrator Interview Method: Virtual interview (Microsoft Teams) On August 6, 2025, 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, Aug 6, 2025