Holy Family Guest Home

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by House Manager Mylene Baldazo. LPA explained the reason for the visit. LPA conducted a case management visit to follow up on a self reported Usual Incident/Injury Report (UIIR) dated March 2, 2026. Per UIIR on February 28, 2026, Resident 1 (R1) passed away. LPA and facility representative conducted a toured of the facility and observed the facility has electricity, water, and gas. Water temperature tested at 110.3 degrees Fahrenheit. Resident bedrooms were observed to have the required furnishings. Certificate of liability insurance was observed to be current. The kitchen was observed to be clean and organized and a 2-day supply of perishable and a 7-day supply of non-perishable food was observed. Medications are kept locked in a cabinet in the activities room. Knives are kept locked in the kitchen. All and any toxic chemicals, cleaning solutions, laundry toxins, and disinfects were observed to be inaccessible to Residents. Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with House Manager Baldazo and a copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Mar 5, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Andrea Mendivil made an announced visit to conduct a pre-licensing inspection. LPA identified themselves and discussed the purpose of the visit with Licensee Fredric Robart an initial application to operate a Residential Care Facility for the Elderly application was received by CCL on 05/15/2025, for a capacity of six residents, 4 non-ambulatory and 1 bedridden resident, and 1 ambulatory resident. LPA Mendivil along with Licensee toured the facility at 09:05AM and observed the following: Structure: Facility is a single story, 5 bedroom, 2 bathroom house with breezeway used as office and attached garage and white exterior. The exit gates are unlocked and self latching. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: 2 bedrooms are single occupancy and 2 rooms are shared. There is 1 staff bedroom. All of the rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: Resident bathrooms have a working toilet/ wash basin .Linens & Hygiene Supplies: Facility has bedding and towels for residents in care. Emergency Phone Numbers and Exit Plan: Posted in facility hallway Food Service: Licensee has 2 day perishable and 7-day nonperishable foods. Smoke Detectors: Smoke detectors/ carbon monoxide detectors were tested and operational. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins/ Sharps: LPA observed a secure area for sharps and toxins. Water Temperature: LPA tested hot water and it read as following: residents bathroom tested between 106.7 and 107 degrees Fahrenheit . Emergency Supplies: LPA observed supply of emergency water and food stored in facility garage. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. CONTINUED ON LIC 809C DATED 02/10/2026 Medication is stored in locked cabinet in facility breezeway. Resident & Staff File: Records are stored in a locked cabinet Reading Material, Games, and Equipment: . LPA observed games and coloring books in facility. Backyard: LPA observed a shaded area for residents. Fire Clearance: Approved for 1 ambulatory, 4 non-ambulatory and 1 bedridden residents on July 9th 2025. Facility is ready to be licensed. Component III completed. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 06 Census : 06 Method: Telephone call with CAB COMP II Participants: ROBART, FREDRIC (administrator); BROWN, JOHNNY (licensee) Administrator/Licensee participated in COMP II via telephone call with CAB analyst. Identification of the Administrator/Licensee was verified by confirming driver’s license number. During COMP II, Administrator/Licensee confirmed the understanding of Title 22. Component II was successfully completed. Administrator/Licensee was advised to email signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Administrator/Licensee'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, Jan 2, 2026