Arise Homes 2

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 Vanegas was greeted and granted entry to the facility by facility staff. LPA Vanegas explained the purpose of the visit, and Administrator (AD) Michelle Labao was notified via telephone and arrived shortly after in order to assist with the annual inspection. Accompanied by AD LPA conducted a tour of the facility and observed the following. AD Michelle Labao has a valid administrators certificate valid from February 01, 2025 through January 31, 2027. The facility is a one storied home with five bedrooms, one of which is a staff room and four of which are resident rooms, three bathrooms, and an attached two car garage. LPA observed kitchen are to be clean and free of any mildew and debris. LPA observed there to be a refrigerator, microwave, gas stove, dishwasher, washer, and dryer. All tested operational. LPA observed there to be a two day supply of perishable food on hand and a seven day supply of non-perishable food on hand. LPA observed all resident rooms to be clean and free of debris. LPA observed all resident rooms to have all required furnishings such as a chair, a bed, clean linens; meaning no strains or tares, a reading lamp, and enough storage space to store personal belongings. LPA observed resident restrooms to be clean and free of any debris and mildew. LPA observed water faucets and toilets to be operational. Restrooms were observed to have all required furnishings such as grab bars, slip resistant flooring, and a shower chair. Hot water temperature tested between 113.2 and 117.5 degrees Fahrenheit. CONTINUED ON LIC809-C. LPA toured the outside of the facility and observed the following. The outside of the facility was observed to have a shaded sitting area, the backyard is large enough to participate in outdoor activities upon resident request. LPA observed for there to be no hazards or obstructions along the exit routes or throughout the backyard. Side exit routes are clear of any obstructions, side doors are self latching and unlocked. LPA reviewed three staff files, and six resident files. All resident files had required documents, however staff files were missing required documents and training. A deficiency was issued on today's date. LPA observed all fire extinguishers to be fully charged and up to date. LPA observed all smoke detectors and carbon monoxide detectors to be operational. LPA observed first aid kit to have all required items including scissors, tweezers, adhesive tape, bandages, a thermometer, and a first aid manual. LPA reviewed medication administration record, and medications. Per LPA review all medications are being administered per physicians orders. Based on today's observations deficiencies will be issued per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with AD Michelle Labao and a copy of this report was provided to the facility additionally a copy of this report will be mailed to the facility.the state’s words, verbatim · CDSS document, Mar 13, 2026

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) Rowena Carrillo was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Rowena Carrillo has a valid Administrator certificate which expires on June 24, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, one of which may be bedridden, and has a hospice waiver for six. The facility is a single story home with five resident bedrooms, one of which can be shared, one staff bedroom, three resident bathrooms, two of which are shared, a living room, a dining room, a kitchen, a laundry room, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed three residents in care, one of which is on hospice, and two care giving staff present. LPA observed residents eating breakfast in the dining room and relaxing in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the dining room. 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 inspected the three 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 132.2 and 134.6 degrees Fahrenheit. LPA observed the staff room to be free of hazards. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The six burner gas stove lights unassisted. LPA observed knives and sharps to be stored in a locked kitchen cabinet. LPA observed the facility has a three day emergency food and water supply stored in the kitchen. CONTINUED ON LIC809-C Fire extinguishers are located in the entryway of the facility, in the resident hallway, and in the two car garage. Fire extinguishers were observed to be charged and up to date on service. LPA tested the wired smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on October 19, 2024. LPA observed a fire place in the living room and it was observed to not be in operation at the time of visit. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit was observed be stored in the locked cabinet and it was observed to have all the required components. The door leading to the laundry room is kept locked and inaccessible to residents in care. LPA observed chemicals and toxins to be stored in in the laundry room. LPA observed additional linens to be stored in the laundry room. The door leading to the attached two car garage is kept locked and inaccessible to residents. The garage is used for storage. 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. There are no bodies of water on the premises. LPA reviewed all three resident files. LPA observed the facility did not have a Reappraisal on file for Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3). LPA reviewed all three residents’ medication and medication records. LPA reviewed three staff files. 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. An exit interview was conducted with Administrator Rowena Carrillo. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 10, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility and was greeted and granted entry. LPA met with Rowena Carrillo, Applicant/Administrator and explained the visit. A change of ownership application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (5) non-ambulatory, and (1) bedridden resident was submitted to CCL on 08/03/23. Structure: The facility is a one-story house with an attached garage with 6 resident bedrooms, 3 full bathrooms, a living room, a dining room, and a kitchen. The residents’ bedrooms are spacious and will easily accommodate the residents’ furnishings. There is a large back yard with a closed patio and one exit walkway on one side of the house with seating for the residents. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 6 private rooms. Bedroom 6 has a full bathroom. Bedrooms Staff: No bedroom designated for wake staff. Bathrooms: The facility has three full bathrooms. All bathrooms have a working toilet, wash basin, and walk-in shower. Linens & Hygiene Supplies: Adequate supply of linen in closet storage in main living room. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the Continued on LIC809-C kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, tested, and found operational. Fire extinguishers mounted/charged in bedroom hallways. Appliances: Gas six burner stove, single oven, refrigerator, microwave, dishwasher, washer, and dryer are clean and noted to be operational. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents and are stored and locked in cabinets in laundry unit. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 113 Fahrenheit degrees in facility bathrooms. Medications, First-Aid Kit & Book: Medication and First Aid kit stored in locked storage cabinet in kitchen. Resident & Staff Files: Records will be kept locked in a storage cabinet in the kitchen. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation. Fire clearance: Was approved on 09/26/23. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Feb 29, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 2 COMP II Participant: Rowena Carrillo, CEO/Administrator Interview Method: Telephone interview On 2/23/24, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 23, 2024