A Faithful Home

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents. Facility has an approved hospice waiver for six residents and the home currently has six residents, with four residents on hospice. Administrator (AD) Amelia Morales assisted with the visit. LPA along with AD toured the facility at 9AM. LPA toured the physical plant, checked food service, and facility documentation. The two story home consists of six resident bedrooms, living room, dining room, and kitchen, two bathrooms and an attached garage on the first floor. The second floor consists of two staff bedrooms and bathroom. No residents reside on the second floor. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 111 degrees F and 116 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Two auditory exit alarms were non-operational or missing from two resident rooms. At 9:05AM, LPA toured the kitchen and observed sharps unlocked in a cabinet during today's visit. The facility does not have a mechanism to lock sharps in the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. At 9:25AM, LPA observed the door to the garage unlocked, making bug spray accessible to residents. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans. Emergency disaster plan was last updated on 8/07/2019. Facility conducts quarterly emergency drills with the last drill conducted on 5/25/2026. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA did not observe any emergency food or water supply. First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed six resident files and three staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Two out of three staff files reviewed did not contain evidence of a health screening. One out of three staff files did not contain evidence of annual training. LPA reviewed medication storage and administration. Medications are stored on the second floor. Medications are being administered per physician order. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Jun 16, 2026

The state marks this report as 12 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Allegation investigated: Facility staff is accessing and misusing funds belonging to residents.

On January 22, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA was granted entry after introducing self and explaining the reason for the visit to Caregiver Emely Sarte. LPA was subsequently greeted by House Manager (HM) Amelia Morales. During the course of the investigation, LPA interviewed two staff and six residents, however LPA was unable to qualify three residents due to their medical condition. LPA reviewed records and requested the following copies to be provided via email at end of business day on today's date: Resident Roster, Personnel Report Summary, Face Sheets, Physician's Reports, Admission Agreement, Needs and Services Plans, and bank statements. The investigation is as follows: Regarding the allegation, Facility staff is accessing and misusing funds belonging to residents, it is alleged that the owner is accessing accounts belonging to Resident #1 (R1) and Resident #2 (R2) by withdrawing repeated charges between $200-$350 for local outings. Unfounded Based on the interviews, R1 and R2 confirmed that the staff were compensated transportation fees for outings in addition to the recurring monthly rent, which they had no concerns about. R1 and R2 confirmed going out in the community for shopping or appointments with a facility staff who is providing care and transportation for several hours a day also corroborated by two out of two staff. R1 and R2 confirmed withdrawing funds themselves and that staff have not been involved. The remaining resident interviewed denied the allegation. In review of the Admission Agreements dated February 15, 2025 for R1 and February 7, 2025 for R2, R1 and R2 are charged a transportation escort fee in the amount of $40.00 per hour per agreement. Based on the investigation, there are no concerns regarding misusing of funds. Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the following allegation: Facility staff is accessing and misusing funds belonging to residents is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with House Manager Amelia Morales and Administrator Theresa Kholoma by telephone, and a copy of this report including the LIC811 were provided at exit.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 22-AS-20260114153349

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 R S Kristian Umali after stating the reason for the visit followed by the live in House Manager (HM) Amelia Morales. The administrator's certificate for Theresa Kholoma is currently valid and expires on August 28, 2027. The following was observed during the inspection: This is a two story property located in a residential neighborhood. Facility operates within the conditions and limitations specified on the license. LPA observed six residents in care with two residents receiving hospice service. LPA observed two caregivers on duty and verified fingerprint clearance and association statuses. All common areas were inspected including the attached two car garage and the attic on the second floor which consisted of two private bedrooms for staff and one bathroom. On the first floor, LPA observed four resident bedrooms and two resident bathrooms. LPA observed the residents' 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. There were no bed rail orders for five out of six residents per review of the resident files. All bathrooms were unclean and unsanitary evidenced by the feces in the toilet bowl in the private bathroom of Resident #1 (R1) and Resident #2 (R2), all bathroom sinks had hard water stains, rust, and pink stains as well as the dirty floor evidenced by the debris and particles. LPA observed staff cleaning the facility approximately 11am. The cold water temperature in R1 and R2's bathroom was not cool enough measuring at 82 degrees Fahrenheit. LPA observed Staff #2 (S2) not following the infection control practices as they did not remove their glove and wash their hands after changing a resident's brief prior to opening the kitchen cabinet. The hot water temperature in the residents' bathrooms measured at 114.9 and 118.4 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. LPA observed the outdoor passageway is free of obstruction. The exit gates were operational and there were sufficient seating and shading. The fire extinguisher was mounted, charged, and serviced on August 22, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational on both floors. LPA observed the emergency food/water and supplies in the garage and below the office desk. Emergency drills were conducted quarterly with the the last date on May 25, 2025. The Emergency Disaster Plan (LIC610E) was not reviewed annually. LPA observed the required 'See Something, Say Something' (PUB475) poster posted in the correct size. LPA interviewed residents/staff, reviewed six residents' files, and two personnel files in which discrepancies were found in the staff files. Medications were audited for two out of six residents. No discrepancies found. The following was discussed: to ensure facility is clean, sanitary, and in good repair at all times, completion of the LIC503s for S1 and S2, to adhere infection control practices, to review the the LIC610E annually and to complete page 9 of the plan, and to obtain bed rail orders for the five residents, (R1, R2, Residents #4-6). Based on the observations made during today's visit, deficiencies are being cited and Advisory Notes are being issued on the attached LIC9102s. An exit interview was conducted with House Manager Amelia Morales, and a copy of this report including the Confidential Names (LIC811s) and the appeal rights provided at exit.the state’s words, verbatim · CDSS document, Sep 17, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

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 Amelia Morales, House Manager and Administrative Designee. During today’s visit, LPA met with Amelia Morales, House Manager since Administrator was out-of-town at time of visit. The facility is a two-story building with an approved fire clearance of six non-ambulatory residents of which one may be bedridden and hospice is approved for six. The facility currently has a census of four residents in care. All residents reside on the first floor. 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 128.9 and 130 degrees Fahrenheit and Caution Hot Water signs are posted in bathrooms until water temperatures are adjusted between 105 to 120 degrees Fahrenheit. All smoke detectors were operational. The fire extinguisher is charged and was serviced on August 23, 2023. The facility’s last fire drill was conducted on April 20, 2024. The PUB 475 poster posted is not the required 20" X 26" size. 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. LPA observed medication storage and reviewed the centrally stored medications. Per review medication appear to be being given as prescribed. LPA reviewed four of four staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. The administrator has a current administrator certificate which expires on April 28, 2025. The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations along with two technical violations. An exit interview was conducted with Amelia Morales, House Manager and Administrative Designee and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, LIC 9102-TV and Appeal Rights.the state’s words, verbatim · CDSS document, Jun 28, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.