Fortune Care Home

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection and met with the Applicant/ Administrator Geraldine Rodriguez. Applicant is applying for Residential Care for Elderly to serve residents for age 60 and above. The requested capacity is six (6) residents, of which one (1) ambulatory, four (4) non-ambulatory and one (1) may be bedridden residents. Four (4) hospice waivers are in place. Facility has an approved Dementia Care Plan. The application is change of ownership. The facility was previously licensed to Loving Care Home, facility # 197801049. Fire clearance: Fire clearance approved Resident room#1 for one (1) bedridden resident and Resident room #4 for one (1) ambulatory resident only. Auditory devices are installed at all exits and operable. Garage is not approved for residents or staff residence. Structure: The property is a single-family residence and is in a neighborhood of the city of Azusa. It consists of five (5) bedrooms, two (2) full bathrooms, one (1) half bathroom, kitchen, dining room, living room with TV, laundry area, front yard, backyard and attached garage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Garage is not accessible to residents and is used as storage. No bodies of water are located at the facility. (- Continued on LIC 809 C -) Appliances, Water Temperature and Toxins: Stove burners, oven, microwave, washer, and dryer working. There are three (3) refrigerators, located in the kitchen and garage. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat. Water temperature is tested at 118.6 degrees Fahrenheit. Poisons, toxins, and cleaning supplies are locked and inaccessible to residents. They are stored separately from food source. Emergency Phone Numbers, Exit Plan, Signages and posters: Emergency Disaster Plan and Labor law poster are posted. Exit Plan are available for review. Menus are available for review. Free landline telephones are available for residents’ use and operable. Indoor for Residents and Outdoor for activity area: Bedrooms have nightstands, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage. Toilet, wash basin, bathtub/shower in bathrooms are operable. Bedrooms are accommodated for residents. Grab bars are maintained for each toilet, bathtub and shower. Sufficient linen/supplies which include pillowcases, mattress pads, blankets and bedspreads are available. Adequate supply of linen, wash clothes and towels are observed. Outdoor activity area is furnished with a gazebo, chairs and tables and in compliance. Shaded area in the backyard at the outdoor activity area is provided. Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, inspected and in good repair. Dishwasher in kitchen properly installed and functioning. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet in the kitchen and inaccessible to residents. Food supply consists of two days of perishable and two weeks of non-perishable was observed. (-Continued on LIC 809 C-) Residents & Staff Files, Medications, First-Aid Kit & Books: Locked cabinets for records of staff and residents are installed and available. Residents’ files are observed. The Applicant will not handle cash resources for residents. Medication is centrally stored in a cabinet which has a lock and is inaccessible to residents. First aid kit has the required items. The facility has recreational materials for the residents’ use and commensurate with the plan of operation. Smoke Detectors and Fire extinguisher: Dual Smoke /carbon monoxide detectors are tested and operable. They are in residents’ rooms and hallways. Fire extinguishers are available in the facility and are fully charged. Finding: No issue was observed during today’s visit. Exit: Exit conference and Component III orientation were conducted with the Applicant/ Administrator Geraldine Rodriguez during this visit. A copy of this report was provided to applicant. 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, the Applicant has been instructed to communicate with the CAB Analyst who is assigned to the applicant’s application.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Geraldine B Rodriguez CEO/ Administrator Interview Method: Telephone interview On August 11, 2026, 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 the 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 Readiness 9. Pre-licensing Facility Grounds Inspection and Operational Readinessthe state’s words, verbatim · CDSS document, Aug 11, 2026