Concordia Guest Home - 3

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad and Regional Manager (RM) Monica Tran for the purpose of conducting a Required – 1 Year Inspection. LPA and RM met with Administrator (AD) Concordia "Cora" Velasco and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 3:00PM, 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 4-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 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 120 degrees F in the 2 resident bathrooms, after corrections. 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 the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 1:15PM, LPA reviewed 3 resident files and 4 staff files, interviewed 2 residents and 1 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 has a lockable latch on the front door requiring a key to exit the front door which was previously used with a wandering resident and a pad lock was observed next to the eastern side exit; based on observation, the fire extinguisher has no documentation that it was purchased or serviced within the last year; based on observation, the common bathroom faucet tested at 128 degrees F; based on observations, the licensee did not ensure staff medications were inaccessible in the non-lockable staff bedroom; based on documents, S3 does not have a health screening; based on documents and admission, S2 and S3 administer medications but have not received 8 hours of medication training in the last year; based on observations and admission, the facility does not have doctor's orders for R2's vitamin D3, B complex and cranberry supplements which the facility has been administering to R2; based on documents, the physician's report for R2 is on the old form and the physician's report for R3 is on the incorrect form and both are missing required information, including behavioral expressions; based on documents and admission, the appraisals for R1 and R2 are over a year old; based on documents and admission, the licensee does not have documentation of emergency disaster drills; and based on observation and admission, R2 had a full bed rail and is not on hospice. 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 LIC421IM. 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 23, 2026

The state marks this report as 13 pages; the online copy we transcribed has 11. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On June 4, 2025 at 1:15 PM 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 was greeted and granted entry by Caregiver (CG) Orlando Delos Angeles. Licensee (LI) Concordia Velasco was contacted over the phone and LPA explained the purpose of the visit. LI Velasco arrived around 1:50 PM and left around 3:20PM. LI Velasco stated that CG Delos Angeles could sign in behalf of the facility. The facility is licensed to operate for four (4) 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: Three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, dining area, kitchen, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with LI Velasco. 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, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.7 and 109.9 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. 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. LPA Kim observed emergency food and water are stored in the pantry next to the facility entrance. The facility has smoke detectors and carbon monoxide detectors that were operable. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). A working telephone (714-990-5952) remains available. First Aid Kit contained all the necessary elements. LPA conducted an audit of all resident files (R1-R4), all staff files (S1-S2), and medication and medication administration record. LPA Kim conducted two (2) resident interviews and one (1) staff interview. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed a bottle of Cascade and a bottle of Finish Jet dry in an unlocked cabinet under the kitchen sink. LPA observed S1 did not have a valid CPR/First Aid certificate, and the PUB475 See Something Say Something measured at 10.5” x14.5” instead of the 20" x 26" requirement. An exit interview was conducted and a copy of this report and appeal rights were provided to Caregiver Orlando DeLos Angeles.the state’s words, verbatim · CDSS document, Jun 4, 2025

Type of visit: Required - 1 Year

On June 10, 2024 at 8:25am, 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 was greeted and granted entry by staff. Licensee Concordia Velasco was contacted over the phone and explained the purpose of the visit. Licensee Velasco stated she won't be here for the visit and Caregiver Orlando DeLos Angeles could sign the report. The facility is licensed to operate for four (4) 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: Three (3) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living room, dining room, kitchen, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with Caregiver DeLos Angeles 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, and Staff Room 1. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.7 and 110.1 degrees F. A comfortable temperature of 73 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, and sharps objects were stored and not accessible to residents. 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. A working telephone (714-990-5952) remains available. First Aid Kit contained all the necessary elements. Evaluation Report Continues on LIC 809-C LPA Kim observed emergency food and water are stored in the pantry next to the facility entrance. The facility has smoke detectors and carbon monoxide detectors that were operable. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA conducted an audit of all resident files (R1-R2), all staff files (S1-S2), and medication and centrally stored medical destruction record. LPA Kim conducted two (2) resident interviews and one (1) staff interviews. 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 Caregiver Orlando DeLos Angeles.the state’s words, verbatim · CDSS document, Jun 10, 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.