Calle Del Cid Guest Home

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 Teresita Escudero after introducing self and stating the reason for the visit. Administrators (Admins) Priscilla Celis and Liza Delacruz and Administrator's Assistant Liza Rebecca arrived on site to assist with the inspection. Admin Celis has a valid certificate expiring on July 7, 2027 and November 18, 2027 for Admin Delacruz. The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of five resident bedrooms and three resident bathrooms. Facility is operating within the conditions and limitations specified on the license as LPA observed six residents in care with four residents under the care of hospice. LPA observed three staff on duty. LPA toured the physical plant with Caregiver Buenaventura Certeza and later with Admin Celis. 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 110.3, 110.3, and 108.1 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample 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 gate is operational, and there were sufficient seating and shading in the patio area. There are no bodies of water on premise, and the fire place was screened appropriately. The first aid kit contains all necessary elements. The fire extinguisher was mounted, charged, and serviced on March 17, 2026. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Facility maintains emergency food and gallon sized water in the garage. A working telephone (949-215-1591) was tested and remains available. Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the entry way in the correct size. LPA reviewed six residents and three personnel files in which no discrepancies were found with the exception of two resident files as no Tuberculosis (TB) tests were obtained. Medications were audited for three of six residents. No discrepancies were found with medication administration and documentaiton. Present staff are background cleared and associated to the facility. Disaster drills are conducted quarterly as last known drill per log was conducted on February 18, 2026. LPA consulted on the following: to ensure all residents obtain a TB test prior to admission, and to obtain disaster supplies noted on the Emergency Disaster Plan (LIC610E). Based on the observations made during today's visit, a deficiency is being cited and a Technical Advisory is being issued. An exit interview was conducted with Administrators Priscilla Celis, Liza Delacruz, and Administrator's Assistant Liza Rebecca, and a copy of this report including the appeals rights were provided at exit.the state’s words, verbatim · CDSS document, May 4, 2026

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

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 Buenaventura Certeza and explained the reason for the visit. Administrator (Admin) Priscilla Celis was unable to come to the facility and authorized staff on duty to sign the report. Admin Celis holds a valid certificate expiring on July 5, 2025. The facility is a single story structure and is licensed to provide services for age range 60 and over for six non-ambulatory. A waiver was granted to provide hospice services to six residents at one time. During today's visit, there are five residents under hospice care and three caregivers on duty. LPA toured the physical plant with Caregiver Akiechelle Regala. Facility was clean and operational with the exception of the refrigerator and freezer which required a deep cleaning as food debris and stains were observed. LPA observed five resident bedrooms and three resident bathrooms. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 119.4, 113.7, and 114.9 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA reviewed the Emergency Disaster Plan (LIC610E) and observed sufficient emergency food and water in the garage and kitchen pantry. 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 gate was self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and serviced on April 11, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly. Last drill was conducted on February 26, 2025. The facility land line number, (949) 215-1591, was tested and remains available. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the entry way in the correct size. LPA conducted a review of all residents and two staff files. Interviews were conducted with residents and staff. Medications were audited, and discrepancies were observed. The following items were addressed with the Admin by telephone at 11:47am: to deep clean refrigerator and freezer, to assemble emergency supplies in one central location, to complete the Medication Administration Record (MARs) at the time medications are administered, to maintain an accurate and up to date list of medications on the MAR, and to ensure as needed (PRN) medications are not transferred into a different container in advance. Based on the observations made during today's visit, a deficiency is being cited and Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted with Caregivers Akiechelle Regala, Buenaventura Certeza, and Dionisio Tagle, and a copy of this report including the LIC809C, LIC809D, LIC9102s, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, May 9, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicants Priscilla Celis, Liza Dela Cruz and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on January 29, 2024. The facility is to have a capacity of 6, of which 6 can be nonambulatory and 0 bedridden. Applicant has requested a hospice waiver for 6 residents. Facility phone number 949-215-1591. LPA observed the following. Structure: The facility is a one story house with an attached 2 car garage with 5 bedrooms, 3 bathrooms, kitchen, dining room, living room and a family room with a screened fireplace. There are 8 exits, one exit door in the family room, one exit door in the garage, a sliding door in the dining room, a sliding door in the living room, the front door, bedrooms 4 has an exit door, bedrooms 1 and 5 have sliding exit doors. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are 5 Resident Bedrooms. Bedroom 5 is shared. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings. Bedrooms Staff: There are no staff bedrooms. Bathrooms: All bathrooms are clean and operational. Linens & Hygiene Supplies: Adequate supply of linen stored in the hallway linen closet. 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: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors and carbon monoxide detectors are hardwired and tested operational. The fire extinguisher mounted on the wall in the kitchen is fully charged. Appliances: There is one 5 gas burner stove which lights unassisted, 1 oven, microwave oven, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All cleaning supplies and chemicals are kept locked in the garage.. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 119.2 to 120.0 degrees Fahrenheit. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in closet in the hallway. The medication will also be kept secured in the hall closet which is kept locked. The first aid kit has all the required elements. Resident & Staff Files: The Resident and Staff Records will be kept locked in the hall cabinet. Reading Material, Games, Equipment & Materials: Reading material and games are stored in the living room. There is a large screen TV mounted in the living room. Fire clearance: Fire Clearance approved by Orange County Fire Authority Inspector Ryan Ferdig on March 11, 2024. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. Applicant was reminded that it is required to notify LPA when admitting their first resident. This notification may be done by phone, email or fax. The facility is ready to be licensed. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Apr 30, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: PRISCILLA CELIS, LIZA DELA CRUZ Interview Method: Telephone interview On April 03, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 3, 2024