Amethyst Care Home of Fullerton

Type of visit: POC

This unannounced POC inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of verifying correction of deficiencies issued during the Required – 1 Year Inspection conducted on October 9, 2025. LPA met with Staff #1 (S1) Flordeliza Villena and discussed the purpose of the inspection. Administrator (AD) Charesa Reyes appeared via telephone. During the inspection, LPA and S1 toured the facility and observed the following: Type B Violation cited under California Code of Regulations (CCR) Title 22, Section 87463(a) pertaining to multiple residents not being reappraised yearly has been cleared. The proof of correction due date was November 6, 2025. LPA followed up with AD multiple times since the proof of correction due date and did not receive proof of correction of this violation. During today’s inspection, LPA reviewed the appraisals for all four current residents and confirmed they are all current. During the inspection, LPA and S1 observed the licensee has a full bedrail on the bed of Resident #1 (R1) who S1 and AD confirmed 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. Civil penalties for repeat violations are being assessed. See LIC421FC. 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, Dec 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(A) · Plan of correction due date: Dec 3, 2025

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. This requirement is not met as evidenced by: Based on observation, the licensee has a full bedrail on the bed of R1 who is not on hospice, which poses an immediate personal rights risk to persons in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Dec 2, 2025

Plan of correction: During the inspection, the licensee removed the full bedrail and LPA confirmed. Licensee stated they will conduct staff training on bedrails and submit proof to LPA by POC due date.

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 Staff #1 (S1) Flordeliza Villena and discussed the purpose of the inspection. Administrator (AD) Charesa Reyes arrived during 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 attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA and AD observed 2 staff and 6 residents present at the facility. 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 one staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 115 and 118 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 the kitchen. Toxins: observed locked in the kitchen and garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 1:45PM, LPA reviewed 6 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 6 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on Guardian records, the licensee did not ensure AD, who is background cleared, was successfully associated to the facility roster as their status has been "in process" for the last year; based on documents, the licensee did not ensure Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #5 (R5), and Resident #6 (R6) were reappraised yearly, as their appraisals are all more than a year old; and based on observation, the licensee has a full bedrail on the bed of Resident #4 (R4) who 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. 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, Oct 9, 2025

Type of visit: POC

This unannounced POC inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of verifying correction of deficiencies issued during the Required – 1 Year Inspection conducted on October 28, 2024. LPA met with Staff #1 (S1) Flordeliza Villena and discussed the purpose of the inspection. Administrator (AD) Charesa Reyes appeared via telephone. During the inspection, LPA and S1 toured the facility and observed the following: Type A Violation cited under Health & Safety Code Section 1569.605 pertaining to liability insurance has not been cleared. During today’s inspection, AD was not able to provide proof of liability of insurance. Civil penalties for repeat violations are being assessed. Type B Violation cited under California Code of Regulations (CCR) Title 22, Section 87205(b) pertaining to the licensee corporation being suspended has not been cleared. During today’s inspection, LPA reviewed California Secretary of State documents showing that the licensee corporation is still suspended and AD has not submitted any proof that the Revivor process has been initiated. Civil penalties for failure to correct are being assessed. 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. Civil penalties for repeat violations and failure to correct are being assessed. See LIC421FC. 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, Dec 4, 2024

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Dec 5, 2024

... all residential care facilities for the elderly... shall maintain liability insurance ... This requirement is not met as evidenced by: Based on documents, admission, and confirmation from the licensee's insurance agent, the licensee's liability insurance expired on January 14, 2024, and has not been renewed, which poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: CIVIL PENALTY ASSESSED. Licensee stated they will obtain liability insurance immediately and submit proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87205(b) · Plan of correction due date: Jan 1, 2025

(b) If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. This requirement is not met as evidenced by: Based on California Secretary of State documents, the licensee corporation is suspended, which poses a potential safety risk to persons in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: Licensee stated they will begin the Rivivor process and submit proof to LPA by POC due date.

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 Staff #1 (S1) Flordeliza Villena and discussed the purpose of the inspection. Administrator (AD) Charesa Reyes arrived during the inspection. LPA reviewed Infection Control requirements. At about 8:15AM, LPA and S1 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 detached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 6 residents present at the facility. 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 one staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 107 degrees F in the common resident bathroom and 106 degrees in the private resident bathroom. 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 the kitchen. Toxins: observed locked in the kitchen and garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:15AM, LPA reviewed 6 resident files and 3 staff files, interviewed 6 residents and 2 staff, and inspected medications for 6 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on California Secretary of State documents, the licensee corporation is suspended; based on documents, admission, and confirmation from the licensee's insurance agent, the licensee's liability insurance expired on January 14, 2024, and has not been renewed; and based on documents, the licensee did not ensure S1 and S2 completed the 10 hour medication training (6 hours hands-on, 4 hours other training/instruction) prior to assisting with medications. 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. An exit interview was conducted andthe state’s words, verbatim · CDSS document, Oct 28, 2024