2592 Ciro

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 2:53PM. The LPA met with the Administrator Jovy Sarreal who arrived shortly thereafter. Entrance interview conducted. Beginning at 3:07PM, the LPA, Administrator, and Staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There was a fireplace in the living room, which was observed to be screened and inaccessible. Attached to the living room was a sun room with an office area in the corner. Also attached to the living room was the garage entrance which was secured and contained emergency food and water, extra facility food, general storage, and laundry machines that were in good condition. The facility maintained a comfortable temperature throughout the visit. The LPA observed required postings on entryway walls. KITCHEN: Knives were stored inaccessible in a drawer in addition to secured cleaning supplies under the kitchen sink. Kitchen appliances were in good and operable condition. The facility had a sufficient supply of perishable and non-perishable food. Resident medications were locked in a cabinet with files. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were five (5) total bedrooms: four (4) resident bedrooms and one (1) secured staff room. All resident bedrooms had a direct exit to the outside and was cleared for a total of six (6) Bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were observed in the hallway. The LPA observed Bedroom #2 did not have a bed and the Administrator ordered a hospital bed to be delivered the next day. There were two (2) total restrooms: one (1) private resident restroom and one (1) shared restroom located in the hallway. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper towels. The shared restroom contained locked cabinets that had extra hygiene supplies and cleaning supplies. Hot water was tested and measured between 103.8 degrees F and 109.4 degrees F, which was in the required range. OUTDOOR AREA: The backyard had a covered patio area equipped with furniture for residents’ use. There were two (2) side gates for emergency exit use and were self-latching. All exits and passageways were free of obstruction. RECORDS: Record review began at 3:37PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, the LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 10/09/2025. Smoke and carbon monoxide detectors were tested at 4:14PM and were operational at the time of the visit. The fire extinguisher was fully charged and serviced on 6/17/2025. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 4:17PM. Medications were centrally stored and kept inaccessible. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of today's report was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 30, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Facility staff did not follow physician's orders

Please note: this is an amendment to the original report issued, as the allegation was incorrectly written. Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation regarding the above noted allegation. LPA initially met with facility staff and explained the reason for today's visit. Administrator Jovy Sarreal and Licensee Gilliana Sherman arrived at the facility shortly after the visit began. Entrance interview conducted. During today's visit, LPA interviewed Administrator at 10:00AM, reviewed Resident #1 (R1)'s file and obtained copies of pertinent documents, LPA conducted a facility tour at 10:44AM, and interviewed 2 (two) staff beginning at 02:10PM. The following was then determined: The complaint alleges that facility staff did not follow physician's orders related to repositioning R1. LPA reviewed R1's file which indicates that R1 was admitted to the facility on 07/26/2024. Interview and record review revealed that R1 was on hospice and had existing pressure injuries/wounds upon admit to the facility. Report Continued on LIC 9099-C Unsubstantiated Although R1's hospice agency took the hospice plan of care and binder from the facility after R1 passed, LPA was able to review Progress Notes for R1. Progress notes indicate that R1's hospice nurse indicated they would contact a wound specialist on 08/14/2024. However, interview revealed that the wound specialist did not make it to the facility before R1 passed away. An unstageable sacral wound was noted on 08/19/2024 and on 08/20/2024, R1's physician ordered "patient to be repositioned on her side every 2 hours." Interview with staff revealed that R1 was repositioned every 2 hours during the day when staff provided incontinence care. Staff indicated there was a log filled out each time they repositioned the resident. However, the hospice agency removed the log from the facility, so LPA was unable to review the document. R1's overall condition worsened and R1 passed away under hospice care on 08/22/2024. LPA attempted to contact R1's hospice agency to discuss the allegation and to obtain pertinent documents, however, LPA did not receive a response. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation "facility staff did not follow physician's orders" is deemed UNSUBSTANTIATED at this time. No deficiencies cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 5, 2024 · control 29-AS-20240828155048

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:25AM. The LPA was greeted by staff and Administrator was contacted via telephone. Administrator Jovy Sarreal arrived shortly after LPA, and the Licensee Gilliana Sherman arrived thereafter. LPA explained the reason for the visit. Entrance interview conducted. Beginning at 10:44AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: LPA observed facility fire extinguisher to be fully charged and last serviced 06/27/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 02:08PM and were functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer to the right of the stove. The supply of dishes is adequate. Appliances in the kitchen were clean and functional. The facility had a sufficient supply of two-day perishable and seven-day nonperishable food. Cleaning supplies were observed in a locked cabinet under the kitchen sink. COMMON AREAS/GARAGE: The facility is a single-story structure with a large sunroom, dining room and living room. The LPA did not observe any obstructions or hazards. At the time of the visit, the living room, sunroom and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Linen closet and locked cabinet containing cleaning supplies and hygiene items was observed in the main hallway locked and inaccessible. The garage is located adjacent to the living room. Garage was observed to be locked and contained an extra refrigerator/freezer, emergency food and water, laundry area, and additional storage. Report Continued on LIC 809-C BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The facility consists of 5 (five) total bedrooms, 4 (four) are designated for resident use with (2) shared rooms and (2) two private rooms and 1 (one) designated staff room. Staff bedroom was locked appropriately. RESTROOMS: The (2) two resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature in the common resident restroom was 116.5 degrees Fahrenheit, which is within the required range. OUTDOOR AREA: The backyard has outdoor covered patio area equipped with furniture for resident use. There is are gates on both sides of the facility and were observed to be self-closing and latching. No bodies of water were noted. RECORD REVIEW: At 11:20AM. a review of facility files was initiated. The LPA obtained a copy of the staff roster and liability insurance. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All 4 (four) of 4 (four) records observed were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All 3 (three) of 3 (three) staff files reviewed were in order. MEDICATIONS: Medications review began at 01:40PM. Medications are centrally stored and locked in a mediation cabinet in the kitchen; medications are labeled and checked for expiration dates. LPA reviewed medications for 2 (two) residents. Medications observed were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control plan and Emergency Disaster plan. Both documents were observed to be complete and updated annually as required. The facility conducts disaster drills quarterly, with the last documented drill on 07/16/2024. INTERVIEWS: During today's visit, LPA interviewed 1 resident and 3 staff. No concerns were noted. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Sep 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 10:20 a.m. The LPA was greeted by staff and met with Administrator Mervin Galvez and explained the reason for the visit. The LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA began the inspection with the Bedrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The facility consists of 5 (five) total bedrooms, 4 (four) are designated for resident use with (2) shared rooms and (2) two private rooms and 1 (one) designated staff room. Staff bedroom was locked appropriately. RESTROOMS: The (2) two resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in bathrooms measured between 118.0-120.0 degrees Fahrenheit. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer to the right of the stove. The supply of dishes is adequate. Appliances in the kitchen were clean and functional. The facility had a sufficient supply of two-day perishable and seven-day nonperishable food. COMMON AREAS: The facility is a single-story structure with a large sunroom, dining room and living room. The LPA did not observe any obstructions or hazards. At the time of the visit, the living room, sunroom and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 74 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The LPA observed fire extinguisher along the dining room wall which was last serviced 06/12/2023. Linen closet and locked cabinet containing cleaning supplies and hygiene items was observed in the main hallway locked and inaccessible. **Continued on LIC 809-C** OUTDOOR AREA: The backyard has outdoor covered patio area equipped with furniture for client use. There is a side gate for client use and is single latched. No bodies of water noted. The garage is where the washer and dryer are held, including emergency supply food items and PPE. Cleaning supplies and disinfectants are kept in in the garage. The garage is locked and inaccessible. RECORD REVIEW: At 11:30 a.m. a review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention, and Insurance liability. The LPA obtained Client Roster, Staff Roster, and liability insurance. Residents’ records review began at 11:30 p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 2:15 p.m.; medications are centrally stored and locked in a mediation cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 6, 2023