Ainsworth Home Care

Type of visit: Prelicensing

On 08/26/26 Licensing Program Analyst (LPA) Mario Leon, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD on 02/06/2026, for Initial with hospice waiver license for a Residential Care Facility for the Elderly (RCFE) to serve six (6) clients, of which five (5) may be non-ambulatory and one (1) may be bedridden. Hospice is approved for six (6) clients in care. Structure: Facility is a single-story house with four (4) client bedrooms, three (3) bathrooms, dining room, kitchen, laundry area, living/activity room and a covered outdoor seating area in the back yard. Bedrooms Residents: Bedrooms A and B have one bed, two nightstands, a bedroom closet and a lamp in addition to overhead lighting. Bedrooms C and D have two beds, two nightstands, a bedroom closet and two lamps in addition to overhead lighting. Bathrooms: Bathrooms have a working toilet, wash basin, and walk-in shower with grab bars and anti-slip mats. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen and hygiene products are stored in a closet in the hallway as you enter Room A. Emergency Phone Numbers, Exit Plan & Menu: The facility has a working landline in the kitchen area. There are two fire extinguishers, both gauges read in green, located in the kitchen and living rooms and have been maintained yearly (dated 03/14/26). Report continues, please see LIC 809-C. Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, inspected, and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet beneath the kitchen sink. Food supply was adequate; stored in the cabinets and refrigerator and consists of the following: canned goods, fruit, meat, and vegetables. Smoke Detectors & Carbon Monoxide Detector: Operational and interconnected. Appliances: Stove burners, toaster oven, microwave, washer and dryer working. There are two refrigerators in the kitchen; one for food and the other for refrigerated medication. There is one deep-freeze, available only for staff. Toxins: Locked/stored in closets and cupboards. Water Temperature: Tested at 112.6°F (degrees Fahrenheit) in bathroom #1 and 116.7°F in kitchen. Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the cabinet behind the dinner table, available for staff use but inaccessible to clients. Reading Material, Games, Equipment & Materials: The facility has board games, books, magazines, and puzzles for the residents' use and align with the plan of operation. Pool/Jacuzzi & Pets: None. Fire clearance: Fire Clearance with the following special conditions: rooms A and B are each able to host one (1) ambulatory resident, Room C is able to host two (2) ambulatory residents and Room D is able to host two non-ambulatory residents. Fire clearance was approved on 05/28/26. Report continues, please see LIC809-C. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. There have been zero (0) deficiencies cited during today's visit. An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Office

Facility Type: RCFE Application Type: Capacity: 6 Census (if any clients in care): COMP II Participants: LINAYAO, KADIGULA/ADMINISTRATOR/APPLICANT Interview Method: Telephone interview On 6/29/26, applicant/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. 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, Jun 29, 2026