Amorvida Guest House

Type of visit: Required - 1 Year

At approximately 10:00 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and met with Claribel Kemper, Designated Responsible Party (DRP). Administrator was contacted via telephone and was unable to attend today's inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with 5 residents in care. Facility is approved for 6 ambulatory residents and has a Hospice waiver for 2. At approximately 10:25 AM, LPA initiated a tour of the facility with DRP and observed the following: Facility is a on story building, was a comfortable temperature, and passageways were observed free from obstructions. Facility has the required postings in the main common areas which are accessible to the public. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of paper, incontinent care, and hygiene products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in regulations. Closets containing cleaning supplies and other items that could potentially pose a risk to residents in care were observed locked. LPA observed two instances where egress devices were not activated or in working order. DRP ordered replacement devices immediately and agreed to ensure operational compliance with regulations moving forward. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were observed centrally stored and locked. There are outdoor shaded seating areas with space for activities. LPA observed residents engaged in activities in common areas. Facility has internet service and an internet access device designated for resident use. Sprinklers and smoke and carbon monoxide detectors were tested and operational during facility's last fire inspection which was conducted 02/2026. Continued on LIC809C... Continued from LIC809C... Fire extinguishers were observed fully charged and were last inspected 10/2025. Emergency disaster plan was reviewed and updated 10/2025. Facility DRP states that facility conducts biannual disaster drills and was unable to provide proof of any drills having been conducted since licensure, (see LIC809D). LPA informed DRP that drills shall be conducted on each shift no less than quarterly. Facility has a back up generator for emergency preparedness. Facility has emergency lighting and a first aid kit. At approximately 11:30 AM, LPA conducted file review of three (3) staff files. Two (2) of three (3) staff files reviewed were observed missing proof of both the required annual and required annual medication training hours, (see LIC809Ds). Additionally, one (1) of three (3) staff files reviewed were observed missing the required proof of health screening. DRP scheduled the staff member for a health screening appointment during today's visit and agreed to ensure facility operates in compliance with regulation moving forward. All staff files reviewed contained proof of current FA and CPR certifications and all of the remaining required documents. At approximately 12:30 PM, LPA conducted file review of five (5) resident files. Four (4) of five (5) resident files reviewed were observed missing one (1) or more of the required documents, (see LIC809D). During today's inspection LPA observed two non-ambulatory residents, Resident 2 (R2) and Resident 3 (R3) in care. The facility's current sketch and fire clearance dated 04/25/2025 do not grant approval for any non-ambulatory residents. The facility does have two resident rooms with sliding glass doors and ramp access. LPA advised DRP to submit a new facility sketch to the Department with a request for a new fire clearance for non ambulatory approval. At approximately 2:30 PM, LPA reviewed medications and medication records which were observed stored and maintained in compliance with regulation. Residents' families mostly coordinate medical and dental appointments as well as transportation to and from appointments but facility will assist as needed and utilizes a third party transportation service when indicated. Facility does not handle P&I cash resources. DRP states that Licensee is in the process of purchasing the facility and agrees to submit a copy of the Deed to the Department for proof of control of property. Continued on LIC809C... Continued from LIC809C... Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC500 - Personnel Roster (updated to include administrator's schedule) LIC610E Emergency Disaster Plan (updated) Facility Sketch (updated) Deficiencies are being cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the deficiencies by the plan of correction date and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with DRP, whose signature on form confirms receipt of this report.the state’s words, verbatim · CDSS document, Aug 6, 2026

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Prelicensing

At approximately 1:30 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a pre-licensing continuation inspection and was greeted by staff. David Cervantes Vibat, Applicant/Licensee was contacted via telephone and stated he is unable to make it to the facility today but gave permission to complete the visit with Gerry Ofiaza, Designated Responsible Party (DRP). This pre-licensing inspection is being conducted for a change of ownership of a Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 6 ambulatory residents. Facility has a dementia care plan and a Hospice waiver for two (2). At approximately 2:00 PM, LPA inspected a locked shed in the backyard which contains personal items, tools, chemicals, holiday decor, and paper and hygiene products. All other areas of concern during the initial pre licensing inspection conducted on 05/21/2025 have since been resolved. Applicant Licensee owns another care facility and is aware of the current regulations and reporting requirements; Component III orientation waived. The pre-licensing evaluation has been completed. License will be granted upon completion of a final review and approval from the Licensing Program Manager. This report was reviewed with DRP and a copy was provided. Exit interview conducted with DRP, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Prelicensing

At approximately 3:15 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a pre-licensing inspection and was greeted by staff. David Cervantes Vibat, Licensee was contacted via telephone and arrived approximately 90 minutes later. This pre-licensing inspection is being conducted for a change of ownership of a Residential Care Facility for the Elderly (RCFE). Fire Clearance has been approved for 6 ambulatory residents. Facility has a dementia care plan and a Hospice waiver for two (2). Licensee/Applicant uses a placement agency. At approximately 3:45 PM, LPA initiated a tour of the facility and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed resident showers with the required non-slip mats and grab bars in place. LPA observed a supply of clean linens, hygiene products, and paper products available for residents. Facility has seven (7) bedrooms; six (6) are resident bedrooms and one (1) is a staff bedroom. Residents' bedrooms have the appropriate furnishings as outlined in Title 22 regulations. There are dishes and cooking supplies for resident use with sharps and other hazardous items kept secured in various designated drawers and cabinets. Cabinets in communal areas of the facility containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods and at least one week of non-perishable foods and an emergency water supply. Continued on LIC809-C... ...continued from LIC809... Licensee has a sample menu in the common area to indicate a healthy and balanced set of meals for residents in care. The facility has a land line which was tested and operational during inpsection. Facility has an internet access device designated for resident use and has internet services. Facility has a designated locked closet for centrally stored medications. LPA observed the facility's infection control plan, first aid kits, PPE, other emergency supplies, and games and activities available for resident use. Facility has a fully charged fire extinguisher, which was last inspected 07/2024. Smoke and Carbon Monoxide detectors were unable to be tested during inspection. Licensee/Applicant will post a hard copy of their administrator's certification and emergency disaster plan. Facility sketch, personal rights information, ombudsman poster and reporting poster are in facility communal areas. Licensee has been informed of association and staff transfer process and agrees to ensure all staff are cleared and associated. The backyard features ramps and walkways for residents. Windows, screens, and blinds are all found to be in good repair. Licensee/Applicant submitted a copy of the facility's lease agreement to the Centralized Application Bureau and agrees to submit proof of liability insurance upon licensure. LPA observed a facility sketch which accurately reflects the floor plan. LPA will return to complete pre-licensing visit, file review and conduct the Component III orientation with the Licensee/Applicant. Exit interview conducted with Applicant, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, May 21, 2025