Delightful Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Esmeralda Flores Quijada after introducing and stating the reason for the visit. Administrator (Admin) Rebekah Buboi arrived on premise. Admin does not have a valid administrator's certificate and registered course work on today's date. The following was observed during the inspection: This is a two story property comprised of five resident bedrooms and two resident bathrooms. The second second floor is occupied by the licensee's family member which residents do not have access to. Facility is operating within the conditions and limitations specified on the license. LPA observed one staff on duty as the second individual was out grocery shopping. LPA observed six residents in care, one of which is receiving hospice service. LPA toured the interior portion of the facility. The facility is clean and in good repair. All common areas were inspected including the attached two car garage. LPA inspected all resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be in compliance, clean, and operational. Slip resistant mats were available. The hot water temperature in the bathrooms measured at 120.0 and 116.7 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates are operational, and there were sufficient seating and shading in the patio area. There are no bodies of water on premise. The fire extinguisher was mounted, charged, and purchased on April 1, 2026. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. Facility maintains emergency food but insufficient water. Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. LPA reviewed one personnel file in which no discrepancies were found. LPA reviewed six of six resident files in which discrepancies were found as there were no current needs and services plan for all residents. Medications were audited for two of six residents. A discrepancy was found as one medication for one resident was not administered timely according to the physician's order. Present staff is background cleared however is not associated to the facility. Staff training is completed per Admin but there were no documentation to verify training was completed. Disaster drills are conducted quarterly as last known drill per log was conducted on March 28, 2026. LPA consulted on the following: to ensure that the resident/personnel files including training documentation are maintained and organized to prevent future delays, to maintain a current and accurate medication list, to ensure medications are administered according to the physician's directions, to ensure staff are associated to the facility prior to working or volunteering, to obtain disaster supplies noted on the Emergency Disaster Plan (LIC610E), and to complete the administrator's courses as soon as possible. Based on the observations made during today's visit, deficiencies are being cited and civil penalty is issued. Technical Violations are also being issued. An exit interview was conducted with Administrator Rebekah Buboi, and a copy of this report including the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Apr 1, 2026

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: POC

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced to follow up on the deficiencies and Technical Violations (TVs) issued during the annual inspection conducted on April 9, 2025, 1:50pm-6:00pm. LPA was greeted and granted entry by Caregiver Jose Segura and explained the reason for the visit. Regarding, 87303(e)(2), Maintenance and Operation, regulation indicates that "the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F." Water temperature was measured today at 118.4 and 120.0 degrees Fahrenheit. Regarding, 87463(h), Reappraisals regulation indicates that "residents receive an annual routine visit." The physical exam date was completed on March 10, 2025 for Resident #1 (R1). Additionally, the Technical Violations (TVs) were corrected. Facility has complied with the terms of the Plan of Corrections (POC). An exit interview was conducted with Caregiver Jose Segura authorized by Administrator Rebekah Buboi via text at 2:28pm, and a copy of this report including the Letter of Deficiency Citations Cleared were provided along with the LIC811 at the end of the visit.the state’s words, verbatim · CDSS document, May 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Jose Segura and explained the reason for the visit. Administrator (Admin) Rebekah Buboi arrived on premise approximately 2:30pm to assist with the inspection. The facility is a two story home licensed to operate for six non-ambulatory residents of which one may be bedridden and maintains a hospice for three. During today's visit, LPA observed four residents in care and one staff on duty. LPA toured the physical plant with Admin and observed the following: There are five resident bedrooms and two resident bathrooms on the first floor. The second second floor is occupied by the licensee's family member which residents do not have access to. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational, however the hot water temperature in the resident bathrooms measured at 123.2 and 131.9 degrees Fahrenheit. All common areas were inspected including the attached two car garage which doubled as a laundry area. LPA observed at least 72 hour supply of emergency food and water. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was serviced on August 15, 2024. The auditory devices and dual-functioning smoke/carbon monoxide detectors were tested and operational with repair, however one detector was missing in a vacant resident bedroom. Emergency evacuation drills are not conducted quarterly. There were no logs showing the drills were being conducted. The first aid kit contains all necessary elements. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was not available. No discrepancies noted with staff record. In review of the resident records, the Physician's Report (LIC602) was not updated for Resident #2 (R2). The following items were addressed during the exit interview: to organize all files/records to prevent a delay in reviewing of the records during an inspection, to amend the Emergency Disaster Plan (LIC610E), to conduct quarterly emergency disaster drills and maintain a log, to install one dual-functioning smoke/carbon monoxide detector in a vacant resident's bedroom, to ensure the hot water is within the required range of 105-120 degrees Fahrenheit, and to obtain an updated medical assessment for R2 that contains all necessary information reflected on the LIC602, Physician's Report. Based on the observations made during today's visit, deficiencies are being cited. Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted Administrator Rebekah Buboi and a copy of this report including the LIC809-Ds, LIC9102s, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose to clear the remaining deficiencies cited on July 12, 2024 from 8:30am -10:40am. Administrator Rebekah Buboi was advised of the visit by telephone approximately 8:25am and arrived on premise at 9:21am. Deficiency cited under Title 22 Regulations 87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. - The electrical covers were replaced by the Admin during the visit and the wall/trim was observed to be completed upon arrival. Deficiency cited under Title 22 Regulations 87618 Oxygen Administration- Gas and Liquid (b) (3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. - Signs were posted in front of the residents' bedrooms and the front door. Deficiency cited under Title 22 Regulations 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. - R1's Physician's Report has been updated. Facility has complied with the terms of the plan of correction. The deficiencies are now cleared. An exit interview was conducted with Administrator Rebekah Buboi, and a copy of this report including the Letter of Deficiency Citations Cleared were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 29, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Francisco Bautista. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and one may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. This facility is a two story home, second floor is staff only. The facility was sanitary. LPA observed multiple uncovered electrical outlets in the living room space and unfinished walls. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were cleaning supplies accessible to residents under the kitchen sink and bathroom sinks. Knives were easily accessible in kitchen drawer. Medications were labeled, as required, but not stored in locked area, making them accessible to residents. No pool or body of water present. Water temperature was measured at 118 degrees F. Per Francisco, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit was complete. No fire drills have been conducted this quarter. No oxygen in-use sign was not present while there is a resident on oxygen. Resident 1's (R1) LIC 602 physician report had not been updated since 2018 and has a diagnosis of a major neurocognitive disorder. Resident 2 (R2) did not have an order for a full bed rail and was not on hospice. Staff records reviewed contained required documentation. Multiple deficiencies were issues on today's date and one technical violation. An exit interview was conducted with Caregiver, to whom a copy of this report, LIC809 D (x3), LIC9102 and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 12, 2024