Concordia Guest Home - 2

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Concordia "Cora" Velasco and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 1:15PM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 6-bedroom, 2-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 3 residents present at the facility in addition to AD. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 2 staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 105 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in a garage cabinet, after corrections. Toxins: observed locked in a garage cabinet, after corrections. Medication cabinet: observed to be relocated and locked, after corrections. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 10:15AM, LPA reviewed 3 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 3 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on documents, the facility does not have an infection control plan; based on observation and admission, the facility lost the keys to the lockable medication cabinet, the lockable knife drawer, and the lockable garage where toxins are stored, leaving these items accessible to three residents who are not assessed to be able to safely handle these items and one of whom can ambulate with a walker; based on documents and admission, S2 and S3 are background cleared, but are not associated to the facility and have been working for three months; based on documents and admission, S2 and S3 do not have documented 40 hour initial training; based on documents and admission, S3 assists with medications but has no documented initial medication training; based on documents, the physician's reports for R1, R2, and R3 are on the old form and do not include required information, including behavioral expressions; based on documents, the appraisals for R1 and R2 have not been updated in over a year; based on documents, there is no emergency disaster plan present at the facility; based on documents and admission, the licensee does not have documentation of emergency disaster drills conducted this year. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jun 16, 2026

The state marks this report as 11 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Allegation investigated: Resident eloped from the facility

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the faciliy by staff and explained the reason for the visit. The Department received a complaint on 09/21/2022 and the initial 10 day visit was conducted by LPA Gutierrez on 09/22/2022. LPA Gutierrez interviewed staff and residents. LPA Mendivil obtained copies of LIC 602 Physician's Report dated 07/14/2020. It was reported that Resident 1 (R1) eloped from the facility. Licensee Concordia "Cora" Velasco stated that R1 walked out of the door and was a few houses down from the facility. Per review of LIC 602 Physician's Report dated 07/14/2020 the resident is diagnosed with dementia and based on LIC 602 is able to leave the facility unassisted. Unsubstantiated Based on interview with Licensee Cora stated residents are able to leave the facility by themselves if the LIC 602 Physician's Report states the resident is able to leave unassisted. Licensee reported that if a resident is not able to leave unassisted they will let the resident out with a caregiver or a family member. Therefore based on the preponderance of evidence through records reviewed and interviews the allegation Resident eloped from the facility is determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. No deficiencies cited. An exit interview was conducted and a copy of this report and confidential names list was providedthe state’s words, verbatim · CDSS document, Jan 23, 2026 · control 22-AS-20220921120629

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 8am. During today’s visit, LPA met with Concordia "Cora" Velasco, Licensee (LE). The facility is a single story home with four resident bedrooms, two live-in staff bedrooms and two bathrooms The facility has an approved fire clearance of six non-ambulatory with a hospice waiver for two residents. The facility currently has a census of four residents in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 107.0 and 107.2 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on February 26, 2024. The facility’s last fire drill was conducted two months ago but documentation was not on-file. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. There is an additional refrigerator and freezer filled with food. All kitchen appliances were in working order and LPA observed the washer and dryer; that are also operational. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. (Continued on LIC 809-C) (Continued from LIC 809) LPA reviewed two of two staff training and fingerprint records and conducted a complete review of resident records. LPA observed one of four residents did not have a Medical Assessment. Two of three residents did not have bed rail orders on file. Deficiencies will be cited. LPA issued a Technical Violation (LIC 9102-TV) to request a visitor obtain fingerprinting. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator, Chona Cruz, has a current administrator certificate which expires on January 24, 2027. Licensee, (LE) Cora Velasco will be obtaining her Administrator's Certificate. LPA spoke with LE regarding the Technical Support Program (TSP) and LE would like to participate. LPA will make the referral for TSP. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Cora Velasco, LE and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 9102-TV, LIC 809-D and Appeal Rights.the state’s words, verbatim · CDSS document, May 30, 2025

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On June 13, 2024 at 8:20am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Licensee Concordia Velasco and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, two (2) staff bedrooms, two (2) bathrooms, living room, dining room, kitchen, attached garage, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Staff Room 1, and Staff Room 2. Bathrooms were found to be clean and operational. A comfortable temperature of 72 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency supplies are in order and complete. The facility has one (1) fire extinguisher that was charged and was serviced on February 26, 2024, smoke detectors, and carbon monoxide detectors were operable.. A working telephone (714-671-6083) remains available. First Aid Kit contained all the necessary elements. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA conducted an audit of resident files (R1-R3), staff files (S1-S2), and medication.. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted, and a copy of this report was provided to Licensee Concordia Velasco.the state’s words, verbatim · CDSS document, Jun 13, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.