Vandelon Homecare Inc. II

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA), Ahliah Sharp and Ivaishia Wright conducted an unannounced annual required visit. Upon entry, LPAs were greeted by Gina Agbayani, caregiver, and informed her of the purpose of the visit. At the time of the visit, there were three (3) staff members, and five (5) residents present one (1) was at the doctors office and returned prior to our departure. Facility Overview: The facility is a one-story home with (6) bedrooms and (5) bathrooms, including an attached garage. There are no pools or known firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 117°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and exceeded the minimum of a seven-day supply of non-perishable foods in addition to emergency supply rations. Continued on LIC809-C.... Continued from LIC809... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with an expiration date of 10/23/2027. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification; five (5) resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPAs reviewed medications for (3) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. LPAs inquired about disposal practices of medication and observed destruction record. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last purchased fire extinguisher on 1/18/2026, with the last fire drill conducted on 1/23/2026, which met department requirements. All facility exits were clear of obstructions. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero(0) deficiencies observed during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Required - 1 Year

On 03/25/25, Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Caretakers Gina Agbayani and Maribeth Dayrit who were informed of the purpose of the visit. The facility has a fire clearance for six (6) Non-ambulatory residents. Only one (1) Bedridden is granted and Hospice waiver is for four (4). Dementia plan of operation is on file. LPA toured the facility with Caregiver Maribeth Dayrit and reviewed records. During the tour, LPA observed the facility is made up of a one (1) story home with six (6) resident bedrooms, five (5) resident bathrooms, a living room, dining room, kitchen and attached garage. All resident's bedrooms had required furniture and lighting. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is also available for the residents in care. LPA observed a hallway cabinet filled with clean towels, blankets, and linen, available for the residents. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA toured the garage and observed an additional refrigerator with perishable foods. LPA observed that in the garage, there is the Laundry section where the washer and dryer are located; LPA also noted the facility secures additional cleaning solutions, laundry detergent, and disinfectants in the locked garage. Caregiver tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed one (1) charged fire extinguishers mounted near the kitchen wall, last serviced on 03/09/26. Medications are secured in a locked cabinet stored in the closet near the entrance. Staff files reviewed include but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, pre-placement, personal rights, house rules, needs and service plans, and updated physician reports. Facility sketch, LTCO, CCL complaint poster, license and emergency disaster plan is posted is posted throughout the facility. During today's visit, LPA did not issue any citations. An exit interview was conducted and a copy of this report was reviewed and provided.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. Resident record review began. Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 118-126.6.0 degrees F with warning labels. Laundry facilities and a locked area is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued from page 1) LPA began review of employee records. Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and expired 10/23/2023 and submitted for renewal on 10/14/2023. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 03/10/2024. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 02/08/2024. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are no deficiency that are being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative at the time of the exit interview.the state’s words, verbatim · CDSS document, Mar 15, 2024