Care Ayesha

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by house manager Angie Hernadez. Administrator (AD) Lester Del Rosario was notified by staff via telephone. For today’s visit, LPA observed a total of six residents in care and two staff members on duty. LPA observed the Administrator's Certificate for facility AD Lester Del Rosario which expires on June 16, 2028. LPA Ramirez toured the interior and exterior portions of the facility with house manager Hernandez. The facility is a single level structure and is licensed for six non-ambulatory residents, of which four may be on hospice and one bedridden. There are a total of six bedrooms, of which one is for staff. LPA Ramirez 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. Two residents are currently using half-rails for postural support. Appropriate physician orders on file for the two residents. There are a total of three restrooms of which one is for staff and two are for residents. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested 107.5 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. CONTINUED ON LIC809-C.., Fire extinguisher was charged, mounted and located by the dining room. Fire extinguisher was last service on June 3, 2026. LPA Ramirez observed the emergency disaster and evacuation plan, which is posted by the entryway Licensee was advised to use the update Emergency Distaste Plan (LIC610E) dated December 2025. Facility had back-up emergency food and water supply located in the garage. LPA observed that the First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard, which both are self-closing and self-latching. No bodies of water were observed. LPA reviewed six resident files and three staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with house manager Hernandez. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Jul 17, 2026

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver Randy Hernandez, and LPA explained the purpose of the visit, set up equipment, and began a tour of the facility and observed the following. This is a one storied home with six bedrooms one of which is a staff room, and five of which are resident rooms. There are two and a half bathrooms, all of which are used for residents in care and the half bath is used for staff and visitors. LPA Vanegas observed the kitchen area to be clean and sanitary. LPA Vanegas observed a microwave, refrigerator, gas stove, dishwasher, washer, and dryer. All appeared to be in good repair, and tested operational. LPA Vanegas observed bathrooms to be clean and free of any mildew or debris, LPA Vanegas observed bathrooms to have all required furnishings such as grab bars, slip resistant floor matts, and a shower chair. LPA Vanegas observed water faucets and toilets to be in good repair and tested operational. LPA Vanegas observed water temperature to be between 102.4 and 103.7 degrees. LPA Vanegas observed all resident rooms to have required furnishings such as chest drawers, clean linens in good repair; meaning no strains or tears, a bed, a reading lamp, a chair, and enough storage space to store personal belongings. Rooms are large enough to walk about freely, and no obstructions were observed blocking entry ways. CONTINUED ON LIC809C LPA Vanegas observed the outside of the facility to be large enough to participate in outdoor activities upon resident request, and an outdoor shaded sitting area was observed to be available for resident use. LPA Vanegas observed no obstructions along exit routes and noted the side gates to be self latching and unlocked. LPA Vanegas observed first-aid kit to have all required items such as adhesive tape, tweezers, scissors, bandages, first aid manual, and a thermometer. LPA Vanegas observed all fire extinguishers to be up-to-date and fully charged. LPA Vanegas observed smoke and carbon monoxide detectors to be in good repair and tested operational. LPA Vanegas reviewed five resident files, and five staff files. All files (Resident and Staff) had all required documents and staff training was up-to-date and documented correctly. LPA Vanegas reviewed medication administration record, and per LPA Vanegas review medications are being documented correctly and administered per physicians orders. Based on today's inspection no deficiencies will be issued per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Lester Del Rosario , and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 25, 2025

Allegation investigated: Covid-19 masking protocols are not being followed Residents were left unsupervised while in care

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced complaint visit to deliver findings from a complaint received in our office on December 27, 2021. LPA received permission from Licensees to leave report with Staff #1, since they were offsite for Bingo. LPA stated the purpose of the visit to Licensees, via phone, and with Staff #1. LPA obtained and reviewed the following documents: Register of Facility Residents from January 5, 2022, LIC 500 Staff Roster, LIC 624 Unusual Incident Report, Resident LIC 601 Identification and Emergency Information, LIC 602A Physician’s Report for RCFE, LIC 603 Preplacement Appraisal Information, and LIC 603A Resident Appraisal. LPA also reviewed PIN 21-38-ASC-the Provider Information Notice on Updated Guidance for the Use of Face Masks, Surgical Masks, and Respirators Related to Coronavirus Disease 2019 (COVID-19) dated August 19, 2021 and PIN 21-21-CCLD COVID-19 Safety Recommendations for the Upcoming Holiday Season dated October 29, 2021. Unsubstantiated (Continued from LIC 9099) During the investigation LPA interviewed three of three staff members, three of three witnesses from the incident on December 27, 2021. Regarding the allegation that masking protocols were not followed, three of three staff members stated they wore masks during that time and that residents were not mandated to wear them since they lived at the residence. All of the residents from the incident date no longer reside at the facility and were not available for interview. One witness stated masks were not being worn by staff. Another witness could not recall if masks were worn. LPA Rosie Quiroz conducted the ten day visit on January 6, 2022 and observed staff were wearing masks. Based on LPA interviews and observations, the allegation that COVID-19 masking protocols were not being followed is Unsubstantiated. LPA Ruppert conducted six of six interviews regarding residents being left unsupervised while in care. Three of three staff stated they were present at the facility. Two of the staff members reside at the facility and stated one was outside throwing away trash and the other staff member was transferring laundry. Two of two witnesses stated the staff members were not inside the facility and were in the backyard. Although staff members were not in close proximity to the residents, staff members remained on the facility property and were available to residents if needed. Therefore, based on interviews conducted and documents reviewed, the allegations Covid-19 masking protocols are not being followed and Residents were left unsupervised while in care are deemed to be Unsubstantiated. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Staff #1 and a copy of this report and Technical Advisory LIC 9102-TA was provided to the facility.the state’s words, verbatim · CDSS document, Dec 23, 2024 · control 22-AS-20211227160124

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20240514125043. LPA was greeted and granted entry into the facility by Caregiver Rizaldy Dimacali. Licensee Angie Hernandez was also present at the facility. During the course of the complaint investigation, it was alleged that the facility manager is not present at the facility and that the manager is always out. LPA reviewed documents including the Personnel Report (LIC500) dated August 26, 2024. Per Personnel Report Licensee/manager Hernandez is scheduled to work at the facility Monday-Friday from 6:00AM-6:00PM. During the initial complaint visit on May 05, 2024 and today's visit LPA observed Licensee/manager present at the facility. During the course of the interviews with Residents, Resident 1 (R1) reported that managers are always at the facility and stated that both managers are excellent care takers. Per R2 anything he needs the managers will get for him. During the course of the interviews the Licensee reported that she and her husband are the managers and stated that they are always at the facility. Per Licensee she and her husband live at the facility. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA Ramirez conducted an exit interview with Licensee Hernandez, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 26, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Caregiver Maynard Datinguinoo. For today’s visit, LPA observed a total of four residents in care and two staff members on duty. LPA observed the Administrator's Certificate for Lester Del Rosario which expired on 6/16/24, however, AD provided proof of payment to show that the certificate is in renewal process. Renewed certificate has not yet been received and is pending. LPA reminded Licensee to post certificate once received. LPA Ramirez toured the interior and exterior portions of the facility with Licensee Angie Hernandez. The facility is a single level structure and is licensed for six non-ambulatory residents, of which four may be on hospice and one bedridden. There are a total of six bedrooms of which five are for residents and one for staff. LPA Ramirez 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. There are a total of two restrooms. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 105.9-107.2 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 located by the residents' bedroom hallway. CONTINUED ON LIC809-C.. LPA Ramirez observed the emergency disaster and evacuation plan, which is located by main entrance. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. There are two gates in the backyard, which both are self-closing and self-latching. No bodies of water were observed. LPA reviewed five resident files and two staff files. LPA interviewed residents and staff present. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Licensee Hernandez. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Jul 10, 2024

Allegation investigated: Staff did not report incidents involving residents to their authorized representatives

Licensing Program Analysts (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on May 14, 2024. LPA was greeted and granted entry into the facility and met with Licensee Angie Hernandez and explained the reason for the visit. Administrator (AD) Lester A. Del Rosario arrived shortly after. This agency has investigated the complaint alleging that staff did not report incidents involving residents to their authorized representatives. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Five of seven individuals interview denied the allegation. During the investigation LPA reviewed the Unusual Indident/Injury Report (UIIR) dated March 25, 2024 for Resident 1 (R1), R2 and R3. Per UIIR on March 22, 2024 R1, R2 and R3 were involved in a car accident, were escorted by the paramedics out of the vehicle and checked for injuries. During the course of the interviews with residents, R1 reported that it was a minor accident and CONTINUED ON LIC9099-C... Unfounded stated that staff notified his Power of Attorney. Per R2 the accident was not the staff's fault and stated that he is self responsible. During the course of the interviews with the authorized representatives for R1 and R3, the authorized representatives reported that they were notified right away and/or shortly after the accident. Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA Ramirez conducted an exit interview with AD Del Rosario, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 23, 2024 · control 22-AS-20240514125043