Early Bird Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with staff Juan Fuentes and was granted entry to the facility. The facility is a (4) bedroom, (3), bathroom home, with a kitchen/dining area, living room, and attached garage. Licensed capacity is (6) current census (6). LPA was accompanied by staff Juan Fuentes 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 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. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents . Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident file for admission agreements, updated physician reports, and needs and services plans. LPA also verified (3) resident's medications and (2) Hospice Files. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. 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 staff Juan Fuentes.the state’s words, verbatim · CDSS document, Jul 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with staff Juan Fuentes and was granted entry to the facility. The facility is a (4) bedroom, (3), bathroom home, with a kitchen/dining area, living room, and attached garage. Licensed capacity is (6) current census (4). LPA was accompanied by Administrator Patsara Chantharaseth, 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 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. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents . Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (2) resident file for admission agreements, updated physician reports, and needs and services plans. LPA also verified (2) resident's medications and (2) Hospice Files. LPA also reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screening. 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 Patsara Chantharaseth.the state’s words, verbatim · CDSS document, Nov 3, 2025

Allegation investigated: Staff handles resident in a rough manner. Staff isolated resident from other residents in the facility.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Licensee William Choi and Licensee Patsara Chantharaseth explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record review. LPA Rico conducted (4) staff interviews and (3) resident interviews. For the allegation, Staff handles resident in a rough manner. During staff interviews, 4 out of the 4 staff stated they have not handled their residents in a rough manner. 4 out of the 4 staff also stated they have not witnessed a staff assist a resident in a rough manner. Unsubstantiated During resident interviews, 2 out of the 3 residents stated staff have not assisted them in rough manner. 1 out of the 3 resident’s was unable to corroborate on the above allegation. In addition, LPA requested video surveillance from the facility’s common areas. LPA did not observe R1 be assisted in a rough manner. For the allegation, Staff isolated resident from other residents in the facility. During staff interviews, 4 out of the 4 staff stated they have not isolated resident from other residents in the facility. 3 out of the 4 staff stated that they encourage residents to be in the common areas and participate in activities. During resident interviews, 2 out of the 3 residents stated they are allowed to spend time with other residents in the living room, dining area and patio. 2 out 3 residents stated they have not felt isolated. 1 out of the 3 resident’s was unable to corroborate on the above allegation. Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. 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 (LIC9099) was discussed and provided to Licensee William Choi and Licensee Patsara Chantharaseththe state’s words, verbatim · CDSS document, Oct 25, 2024 · control 56-AS-20241001132605

Allegation investigated: Staff inappropriately touched resident in care. Staff forced resident to be spoon fed.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Licensee William Choi and Licensee Patsara Chantharaseth and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record review. LPA Rico conducted (4) staff interviews and (4) resident interviews. For the allegation, Staff inappropriately touched resident in care. During staff interviews, 4 out of the 4 staff stated they have not touched a resident inappropriately in care. 4 out of the 4 staff stated they have not witnessed a staff inappropriately touch a resident. During resident interviews 3 out of the 4 residents stated they have not been touched inappropriately. 1 out of the 4 resident was unable to corroborate on the above allegation. Unsubstantiated For the allegation, Staff forced resident to be spoon fed. During staff interviews, 4 out of the 4 staff stated they have not forced a resident to be spoon fed. 4 out of the 4 staff stated that residents are independent with meals but will assist resident’s when needed. During resident interviews 3 out of the 4 residents stated they have not been forced to be spoon fed. 1 out of the 4 residents was unable to corroborate on the above allegation. Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. 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 (LIC9099) was discussed and provided to Licensee William Choi and Licensee Patsara Chantharaset.the state’s words, verbatim · CDSS document, Oct 25, 2024 · control 56-AS-20240503162127

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Mary Rico met with Licensee William Choi and Licensee Patsara Chantharaseth to initiate case management visit. The investigation consisted of observation, interviews, and a review of pertinent documentation. During record review, LPA Rico review staff criminal record clearance and staff schedules. LPA Rico observed S1 has been working at the facility since 9/8/2024 without a criminal record clearance. In addition, LPA asked the Licensee if S1 had received their clearance letter. Licensee indicated S1 fingerprint is in process. LPA informed the Licensee that S1 is not allowed to work at the facility until they have an eligible clearance. During today’s visit the facility a deficiency will be issued and Civil Penalties were assessed with the amount of $500.00 for S1 An exit interview was conducted where this report (LIC809), (LIC809D), (LIC421BG) and Appeal Rights were discussed and provided to Licensee William Choi and Patsara Chantharaseth.the state’s words, verbatim · CDSS document, Oct 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Oct 4, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above by not obtaining Staff #1 (S1) criminal record clearance before allowing S1 to work at the facility since 9/8/2024 which pose immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 3, 2024

Plan of correction: Licensee stated to not allow S1 to work at the facility without obtaining the required Criminal background clearance and submit copy of Staff Schedule and Personnel Summary Report (LIC500) to LPA Rico at Plan of Correction due date. POC 10/4/2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto visited the facility unannounced to complete a comprehensive annual inspection. LPA Prieto met with Chantharaseth, Patsara Licensee explained the purpose of the visit. Today’s inspection included a facility tour, record review, and interviews with staff and residents. The facility is five (5) bedrooms and three (3) bathrooms of which four (4) bedrooms are used for residents in care. The facility also has kitchen/dining area, living area, covered patio, and attached garage. Licensed capacity is six (6), and the facility is at maximum capacity. Physical Plant: There are no obstructions to indoor and outdoor passageways. The facility temperature is 76 degrees Fahrenheit. LPA inspected resident bedrooms; each room included required furniture such as mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were functional. LPA Prieto observed adequate furniture and lighting throughout the facility. The hot water temperature tested at 117.0 degrees Fahrenheit. The facility has operating smoke detectors and carbon monoxide alarms, which LPA Prieto tested during the visit. LPA Prieto observed personal rights posters, Licensing documents, and the disaster plan posted throughout the facility. LPA Prieto observed that cleaning supplies, toxins, sharps, and other dangerous items are kept secure and inaccessible to residents in care. There was a designated storage space for client/staff files. LPA Prieto observed medications locked and inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient in number for residents in care. The facility has a variety of food available for clients. Dishes, cups, and utensils were also appropriately stored. Care & Supervision: The facility staff is sufficient in number for the care and supervision of residents in care. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA Prieto reviewed three (3) client files for admission agreements, updated physician reports, and needs and services plans. Medications were audited randomly and appeared to be dispensed appropriately by staff members. LPA Prieto reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. No deficiencies were cited during today's visit. LPA Prieto conducted an exit interview with Chantharaseth , where a copy of this report was discussed and provided.the state’s words, verbatim · CDSS document, Sep 19, 2024

Type of visit: Case Management - Deficiencies

On 05/07/2024 at 01:30 PM, Licensing Program Analyst (LPAs) Melody Brown and Sarina Ramirez met with Licensee/Administrator Patsara Chantharaseth to initiate Case Management Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation. During the facility visit today, 05/07/2024, Licensing Program Analysts (LPA) Melody Brown and Sarina Ramirez requested a copy of the facility’s Personnel Report (LIC500) and LPAs Brown and Ramirez reviewed document received and cross reference Guardian database and observed that Staff #2 (S), and Staff #3 (S3) have their background clearance, but they were not associated to the facility as their criminal background clearance was not transferred to the facility. Moreover, during the facility visit today, 05/07/2024, LPAs Brown and Ramirez informed Licensee/Administrator Chantharaseth that deficiency will be issued and Civil Penalties were assessed during the facility visit today with the amount of $300.00 for S2 and $200.00 for S3 and will continue to be assessed of $100.00 per day per citation until corrected for not transferring criminal record clearance for S2 and S3 for not S2 and S3 criminal background clearance to the facility. In addition, during the tour of the facility, LPAs Brown and Ramirez observed two (2) beds set-up in the common area of the home. LPAs Brown and Ramirez explained to Licensee/Administrator Chantharaseth that no room commonly used for other purposes shall be used as sleeping room. Deficiency will be issued. Furthermore, LPAs Brown and Ramirez observed that no staff's schedule to work at night shift and per documents review, the facility has a dementia resident and LPAs observed no night supervision at the facility. Deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Patsara Chantharaseth.the state’s words, verbatim · CDSS document, May 7, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(2) · Plan of correction due date: May 17, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing... (2) Request a transfer of a criminal record clearance...This requirement is not met as evidenced by: Based on observation, interviews and records review, the Licensee did not comply with the section cited above by not transferring Staff #2 (S2) and Staff #3 (S3) criminal background clearance to the facility before allowing S2 and S3 to work at the facility which pose potential safety risks to residents in care.the state’s words, verbatim · CDSS document, May 7, 2024

Plan of correction: Licensee stated to transfer S2 and S3 criminal bacjground clearance to the facility and submit proof to LPA Brown on Plan of Correction (POC) due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a)(2)(B) · Plan of correction due date: May 17, 2024

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy... (2) Resident bedrooms shall be provided which meet, at a minimum,...(B) No room commonly used for other purposes shall be used as a sleeping room... This requirement is not met as evidenced by: Based on observation, interviews and records review, the Licensee did not comply with the section cited above by using the common room as a sleeping area for staffs which poses potential health, safety and personal rights risks to resident in care.the state’s words, verbatim · CDSS document, May 7, 2024

Plan of correction: Licensee stated to transfer staffs sleeping area to a bedroom and submit proof to LPA Brown on POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: May 8, 2024

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia...(4) There is an adequate number of direct care staff to support...(A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined... This requirement is not met as evidenced by: Based on observation, interviews and records review, the Licensee did not comply with the section cited above by not scheduling a staff to work on a night shift to provide night supervision to a dementia resident which pose immediate health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, May 7, 2024

Plan of correction: Licensee stated to schedule a staff to work on a night shift for night supervision and submit proof of updated staff schedule or Personnel Summary (LIC500) to LPA Brown on PLan of Correction (POC) due date.