Quality Senior Living

Type of visit: Required - 1 Year

On today;s date, Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by facility staff. LPA explained the nature of the visit, and Administrator (AD) Maria Tente was notified, and arrived shortly after to assist with the annual inspection. LPA began a tour accompanied with AD and observed the following. AD has a valid Administrator certificate that is valid from December 4, 2024 thought December 3, 2026 The facility is a two storied home with eight bedrooms, five of which are resident rooms, and three of which are staff rooms, five bathrooms two of which are private resident bathrooms, two of which are shard resident bathrooms, and one of which is a staff bathroom, and an attached two car garage. LPA observed the kiten area to be clean and free of any mildew. LPA observed there to be a refrigerator, microwave, gas stove, dishwasher, washer and a dryer in the facility. All appeared to be in good condition and tested operational. LPA observed a two day supply of perishable food, and a seven day supply of non-perishable food as well a sufficient amount of emergency water on hand. LPA observed all resident rooms to be free of any hazards and debris. LPA observed all bedrooms to have all required furnishings including a bed, clean linens in good repair; meaning no strains or tares, a chest of drawers, a reading lamp, and enough storage for personal belongings. LPA observed resident bathrooms to be clean and free of any mildews and debris. Water faucets and toilets tested operational. Hot water temperature tested between 113.4 and 117.3 degrees Fahrenheit, grab bars, slip resistant floor matts and shower chair were observed to be in resident bathrooms. CONTINUED ON LIC809-C LPA Vanegas observed all smoke detectors and carbon monoxide detectors to be operational. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, scissors, tweezers, bandages, a thermometer, and a first aid manual. LPA observed fire extinguishers to no have a service tag, or a recent receipt attached to it, it was not made aware of it was recently purchased or serviced. A deficiency was issued on today's date. LPA reviewed two resident files and two staff files. All files (staff and resident) were all up to date, and had required items. Staff training was not up to date and a deficiency was issued on today's date. LPA reviewed medications with AD and observed all medications to be documented correctly. Per LPA review medications are being administered per physicians orders. LPA toured the outside of the facility and observed the outside of the facility to be clean and free of any hazards, and debris. LPA observed backyard of the facility to be large enough to participate in outdoor activities upon resident request. LPA observed an outdoor shaded sitting area, and a fully fenced pull with the fence measuring five ft tall, and gaps in between the railing measured to be four inches. Based on today's observations deficiencies will be issued per title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conduced with AD Maria Tente, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 30, 2026

Allegation investigated: Lack of care and supervision

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Multiple calls to administrator Maria Tente were made to notify her of the visit and present the allegation under review. Administrator was unable to be present and gave staff permission to sign the present report. During the visit, LPA conducted a tour of the facility's physical plant. There are currently three residents in care. Resident records for all three residents were requested along with hospice records for resident R1. Resident and staff interviews were conducted or attempted during the visit. An additional witness interview with R1's responsible party and attorney-in-fact was also conducted during the investigation. CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation of Lack of care and supervision, the following has been concluded: Resident R1 was admitted at the facility on November 15, 2022 with a primary diagnosis of atherosclerotic vascular disease. At the time of admission, R1 was also admitted under hospice care. On January 2, 2026, R1 sustained a fall incident while receiving showering care from a hospice bath aide. Caregiver S1 present is stated to have immediately called 911 prior to notifying administrator Maria Tente who in turn notified R1's responsible party and attorney-in-fact. R1 was brought to MemorialCare Saddleback Hospital and admitted until January 7, 2026. R1 was re-admitted on hospice upon their return to the facility. Test and examination performed at the hospital appear to indicate that the fall was the result of a stroke. No delay in calling the paramedics has been evidenced during the investigation. Adequate incident reporting to the Regional Office was additionally performed. As a result, the allegation is found to be Unsubstantiated, meaning that based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 22-AS-20260106153708

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted a case management visit to document deficiencies observed during the investigation of complaint 22-AS-20260106153708. Based on observation, interview and records reviewed, LPA determined that three out of three residents were currently receiving hospice care. At this time, the hospice waiver capacity authorized by the Department is limited to two residents on the premises. A type B deficiency is therefore cited. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(2) · Plan of correction due date: Feb 12, 2026

Per CCR 87633(a)(2):The licensee shall be permitted to accept or retain residents (...) to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met:(...) (2)The licensee remains in substantial compliance with the requirements of this section. This requirement is not met as evidenced by: The current waiver in place has a capacity of two residents while three current residents are receiving hospice care. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Licensee stated they would re-submit a request to increase the hospice capacity under the waiver that had previously been submitted to the Department.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Maria Tente was notified via telephone but could not arrive to assist with the inspection. LPA observed that Administrator Maria Tente has a valid Administrator certificate which expires on December 3, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for two. The facility is a two story home with five resident bedrooms, one of which is shared, three staff bedrooms, four resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by a care giving staff conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, two of which are on hospice, and two care giving staff present. LPA observed residents relaxing in the living room as well as their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the four resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 108.1 and 113.3 degrees Fahrenheit. LPA observed that one of the shared resident bathrooms had a common wash cloth for all resident use. LPA observed the second story of the home to be for staff use only and to be off limits to residents in care. LPA observed all three staff bedrooms to be locked and inaccessible to residents in care. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. CONTINUED ON LIC809-C LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed that the lock on the kitchen cabinet where knives and sharps are being stored was inoperable at the time of visit making them accessible to residents in care. A fire extinguisher is located in the kitchen and it was observed to be charged and serviced on May 30, 2024. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility has not conducted an emergency disaster drill. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit is stored in the locked kitchen cabinet and it was observed to have all the required components. The door leading to the attached two car garage is kept locked and inaccessible to resident. The garage is used for storage and laundry. LPA observed chemicals and toxins to be stored in the locked garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA and the AD conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gate on the north side of the facility is self-latching and can be opened in an evacuation. LPA observed a pool located in the backyard. The pool is adequately fenced and is kept locked for resident safety. LPA reviewed all five resident files. LPA observed that the facility did not have a Pre-admission appraisal on file for Resident #1 (R1), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5). LPA observed the facility did not have a Reappraisal on file for R1, R2, R3, R4, and R5. LPA observed that the facility did not have a Medical Assessment on file for R4 and R5. LPA reviewed all five residents’ medication and medication records. LPA reviewed three staff files. LPA observed that Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) did not complete the required annual training for the year of 2024. LPA observed that 0 out of the 3 care giving staff do not have a valid CPR training card on file. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies are being cited per Title 22 of the California Code of Regulations. LPA spoke with Administrator Maria Tente via telephone who provided permission for Caregiver Felijun Casuyon to be the authorized representative since she could not arrive to assist with the inspection. An exit interview was conducted with the facility's authorized representative. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 6, 2025

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by house manager (HM) Felijun Casuyon. LPA observed the administrator certificate for Maria Tente, which expires on 12/3/2024. The PUB475 "See Something, Say Something" poster was also observed to be posted at the entrance. Facility is licensed for 6 non-ambulatory residents, of which 2 may be on hospice. During this visit, there are a total of 5 residents in care, of which 2 are on hospice and 2 staff on duty. LPA De Perio toured the interior and exterior portions of the facility with HM Cauyon. The facility is a two level structure. On the first floor, there are a total of 5 bedrooms, of which 4 are private resident rooms, and 1 shared resident room. On the second floor, there are a total of 3 bedrooms, of which are only for staff. During this visit, LPA observed and verified that there are no residents residing on the second floor. LPA De Perio toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. On the first floor, there are a total of 4 bathrooms for residents, and 1 bathroom on the second floor for staff. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 107.7 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the living room. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPA De Perio observed that First Aid Kit had all the required components. Medications and toxins were observed to be locked and made inaccessible to residents in care. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. No bodies of water were observed. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. An exit interview was conducted with HM Casuyon. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Mar 23, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced case management visit to the facility. LPA explained the purpose of today's visit, and met with house manager (HM) Felijun Casuyon. During this visit, LPA conducted a follow up for a report received on 3/6/24. LPA conducted a tour of the facility and observed that there were no health and safety concerns noted. LPA conducted an interview with HM Casuyon and facility administrator (AD) Maria Tente via phone call regarding the incident. For this visit, no citations were issued. An exit interview was conducted with HM Casuyon. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Mar 23, 2024