Ressa Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Hernandez met with Administrator Ariel Angeles. The capacity is (6) current census is (4). The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room and attached garage. The facility is Residential Care Facility for the Elderly (RCFE). LPA Hernandez was accompanied by Administrator Ariel Angeles to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Hernandez inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Hernandez observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCL complaint poster, the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. **Continuation on LIC809-C** Record Review: LPA Hernandez reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed three (3) residents medications. LPA observed medication for Resident #2 (R2) to be transferred from original container to different container. Deficiency will be issued. Additionally, LPA observed PRN medication for R2 was administered but not properly documented with date, time, PRN medication taken, dosage taken, and resident's response. Deficiency will be issued. LPA Hernandez reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with Tuberculosis (TB) test result. LPA observed Staff #1 (S1) and Staff #2 (S2) do not have required 40-hour training as stated in regulation. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were' cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Ariel Angeles. Along with a copy of appeal rights.the state’s words, verbatim · CDSS document, Feb 20, 2026

Allegation investigated: Staff refused to take resident back into care. Unlawful eviction.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Ariel Angeles and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record reviews. For the allegation, Staff refused to take resident back into care. On 7/3/2025 the hospital attempted to return R1 back to the facility, Administrator admitted they did not accept R1 back to the facility due to behaviors. Per staff interviews, S2 confirmed the Administrator did not accept R1 back to the facility. For the allegation, Unlawful eviction. Per interviews, the Administrator informed LPA that they did not provide a 30-Day Notice Eviction to R1. The Administrator indicated that R1 was not an official resident. Based on record review, R1 had signed the pre-admission agreement and was charged five hundred dollars. Furthermore, R1 was charged and an additional five-hundred dollars for his two night stay, a total of one thousand dollars. Substantiated During resident interviews, R1 confirmed that one thousand dollars was withdrawn from their bank account for their two night stay. LPA received a copy of R1’s bank receipt and confirmed the one thousand dollars was withdrawn. In addition, LPA observed that no 30-Day Eviction Notice was sent to Community Care Licensing. Based on the evidence gathered during today’s investigation, the two (2) allegations listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because of the preponderance of evidence the standard has been met. During today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Ariel Angeles along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jul 22, 2025 · control 56-AS-20250708095846

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468(a)(20) · Plan of correction due date: Jul 22, 2025

87468(a)(20)To be protected from involuntary transfers, discharges, and evictions.. state.. and relocation protections for residents. For purposes of this paragraph.. means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident This requirement wasn't met as evidenced by: Based on interviews, the Administrator did not accept R1 back to the facility which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87468(A)(20) and will send a self-verification letter they have read and understood the regulation. POC due date 7/23/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a)(2) · Plan of correction due date: Jul 23, 2025

87224(a)(2) Eviction Procedures... (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5).... This standard wasn't met as evidenced by:Based on interviews, observation and record review, the licensee did not provide R1 and 30-Day Eviction Notice which poses an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2025

Plan of correction: Administrator has agreed to review the entire Eviction Procedures regulation and complete a statement of understanding and provide a signed and dated copy to LPA Rico POC due date 7/23/2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced case management visit pertaining to complaint control number (56-AS-20250708095846). LPA met with Administrator Ariel Angeles and explained the purpose of the visit. LPA Rico conducted staff interviews, resident interviews, and reviewed documents. During the complaint investigation, S1 informed LPA that they went to R1’s bank to withdraw one thousand dollars cash with R1's debit card. S1 also admitted that R1 was not present. During the resident interview, R1 informed LPA that one thousand dollars was withdrawn from their bank account without their approval, they also indicated they were not present. Based on record review, LPA observed that an amount of one thousand dollars was removed from R1’s bank account. Furthermore, LPA Rico reviewed R1 physician report which indicated R1 is unable to manage their own cash resources. A deficiency will be issued. In addition, the facility did not have residents' cash resources maintained as a drawing account which would include ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. A deficiency will be issued. It was also revealed the facility did not have a surety bond. The Administrator also confirmed they did not have a surety bond. A deficiency will be issued. Based on the information gathered today’s visit three (3) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809D) was discussed and provided to Administrator Ariel Angeles. Along with a copy of appeal rights.the state’s words, verbatim · CDSS document, Jul 22, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87216(a) · Plan of correction due date: Jul 23, 2025

87216(a) Bonding Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement wasn't met as evidenced by: Based on record review the Licensee did not have a surety bond which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87216(a) and will send a self-verification letter they have read and understood the regulation. POC due date 7/23/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87217(g)(1) · Plan of correction due date: Jul 23, 2025

87217(g)(1)Safeguards for Resident Cash, Personal Property, and Valuables Records of residents' cash resources maintained as a drawing account shall include a ledger accounting... for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current This requirement wasn't met as evidenced by: Based on record review the Licensee did not have a copy of R1 ledger account which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87217(g)(1) and will send a self-verification letter they have read and understood the regulation. The Administrator stated they will submit an in-service training for all staff members. POC due date 7/23/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(3) · Plan of correction due date: Jul 23, 2025

87468.1(3) Personal Rights of Residents in All Facilities To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement wasn't met as evidenced by: Based on record review the Licensee withdraw one thousands dollar from R1 bank account which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2025

Plan of correction: The Administrator stated they will read the regulation cited 87217(g)(1) and will send a self-verification letter they have read and understood the regulation. The Administrator stated they will submit an in-service training for all staff members. POC due date 7/23/2025

Type of visit: Required - 1 Year

On 02/24/2025 at 9:00 AM, Licensing Program Analysts (LPA) Beena Singh and LPA Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with Administrator Ariel Angeles and was granted entry to the facility. At the time of the visit there were two (2) staff present, and four ( 4) residents present. LPAs Singh and LPA Brown explained the purpose of the visit to Administrator Ariel Angeles. The facility has 4 bedrooms, in which 3 bedrooms are designated for residents, and 1 bedroom is designated for staff, 2 bathrooms, living room, kitchen, dining area, backyard, and attached garage. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) residents may be bedridden. The current census is four (4) residents. The facility has approved hospice waiver for six (6) residents. LPAs Singh and Brown were accompanied by Administrator Ariel Angeles to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. The facility is maintained at a comfortable temperature. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. Although there were no night lights leading to Non-private bathrooms, deficiency will be issued. bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. In addition LPAs observed Resident #2 (R2), Resident #3 (R3) and Resident #4 (R4) have half bed rail and per records review, R2 R3 and R4 do not have a written order from their physician indicating the need for half bed rail for mobility. Deficiency will be issued. ***Continuation in LIC809C*** ***This is an amended report of LIC 809 Facility evaluation Report issued on 02/24/2025*** LPAs Singh and Brown observed that additional room was added in the garage area with window, air conditioner, lights and full bathroom but per records review no letter was submitted to CCLD for the alteration made and no permit was obtained from city permit building department. Deficiency will be issued. LPA Singh measured and observed the water temperature in the residents bathroom to be at 115 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were not locked and accessible to residents in care. Deficiency will be issued. In addition, LPAs Singh and Brown observed the facility not having the required first aid book/manual maintained at the facility. Deficiency will be issued There was a designated storage space for resident/staff files. Medications are kept inside the medication cabinet, however, LPAs Singh and Brown observed centrally stored medications are not locked. Deficiency will be issued. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Although, there is no emergency supplies, water and food. Deficiency will be issued. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. ***Continuation in LIC 809C*** Record Review: LPAs Singh and LPA Brown reviewed two (2) resident file for admission agreement, updated physician report, centrally stored medication list and needs and services plan. LPAs observed Resident#1(R#1) does not have the required pre-placement appraisal maintained in R#1 file. Deficiency will be issued. LPAs observed residents#4(R#4) does not have the record needs and services plan/care plan maintained in R#4 file. Deficiency will be issued. LPAs observed residents#4(R#4) does not have the record needs and services plan/care plan maintained in R#4 file. Deficiency will be issued. LPAs reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. LPAs observed staff#2 (S#2) working at the facility with a criminal background clearance but S2 criminal background clearance was not transferred to the facility. Deficiency will be issued and civil penalty of $500.00 will be assessed today and will continue to be assessed of $100 per day until corrected. LPAs observed Staff#2(St#2) and Staff#3(S#) do not have the required on the job training maintained in their facility file. Deficiency will be issued. LPAs observed Staff#2 and Staff#3 do not have the required Tuberculosis(TB) test with TB test result maintained in their facility file. Deficiency will be issued. LPAs observed that Staff#2 and Staff#3 did not have health screening in the file. Deficiency will be issued. LPAs observed Staff#2(S2) and Staff#3(S#3) do not have the required 40 hours training maintained in their facility file. Deficiency will be issued. LPAs observed Staff#2 and Staff#3 do not have the required 10 hour of initial training, 6 hours of hand on shadowing, and 4 hours of other training or instructions on assisting residence with self- administration of medications. Deficiency will be issued. LPAs observed that staff#2 and Staff#3 do not have the required Dementia training maintained in their file. Deficiency will be issued. Medications/MARs records were audited and appeared to be dispensed and logged appropriately. Based on the observations made during today’s visit, deficiencies were issued and cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) LIC 809C, LIC809D, LIC 421BG(6/17) and Appeal Rights were discussed and provided to Administrator Ariel Angelesthe state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Ariel Angeles and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is five (5) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathrooms to be at 105.5 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to the residents in care. There was a designated storage space for resident and staff files. The medications are kept inside a cabinet in the kitchen inaccessible to the residents. The non-perishable and perishable food supply is sufficient for the residents in care. The facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA reviewed four (4) residents files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Ariel Angeles.the state’s words, verbatim · CDSS document, Jan 24, 2024