Famous Home

Allegation investigated: Licensee is not following proper eviction procedures with resident in care. Staff retaliated against resident in care. Staff do not ensure that resident is provided with medical equipment as necessary.

Licensing Program Analyst (LPA) Tena Herrera made an unannounced subsequent visit to investigate the above-mentioned allegations. LPA met with Licensee Fedelia Daiz and explained the purpose of the visit. The investigation consisted of the following: On 3/26/24 LPA Yolanda Delgado interviewed one (1) staff and requested and obtained copies of pertinent documentation. On 5/22/26 LPA Herrera conducted phone interview with 1 Staff (S1). During todays visit LPA Herrera conducted interview with 1 Staff (S2), 4 Residents (R1-R4), and delivered findings on the reported allegations. (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Licensee is not following proper eviction procedures with resident in care. It is alleged that R1 was not issued with an eviction notice and staff were verbally telling R1 they can no longer live at facility and taking R1 to look at other facilities for R1 to be transferred to. LPA interviewed 2 Staff and each denied the allegation stating that they did not evict R1 from facility and that R1 left because they were unhappy here and found another facility to reside at, R1 self-discharged from facility. LPA interviewed 4 Residents and each denied the allegation and stated that they have never been issued an eviction noticed or been threatened with an eviction. Allegation: Staff retaliated against resident in care. It is alleged that R1 is being evicted due to complaints and concerns that have been brought up to the Administrator. LPA interviewed 2 Staff and each denied the allegation stating that they have never retaliated against any of the residents and have never witnessed other staff do this. LPA interviewed 4 Residents and each denied the allegation and stated that they have never been retaliated against, R1 and R3 stated they have brought up complaints to staff before and they were not treated any different after voicing their complaints/concerns. Allegation: Staff do not ensure that resident is provided with medical equipment as necessary. It is alleged that R1 needs a nebulizer for their condition and staff have not assisted in ensuring R1 has the needed medical equipment. LPA interviewed 2 Staff and each denied the allegation stating that they make sure resident have all the medical equipment, their medication and attend their medical appointments as needed. Staff stated that R1 always kept their nebulizer on hand while at the facility and this concern/issue was never brought to their attention. LPA interviewed 4 Residents and each denied the allegation and stated that they have never had an issue with this and staff help with all their medical needs. Based on statements and interviews conducted, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 24, 2026 · control 18-AS-20240322130839

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Licensee, Fildelia Daiz who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (5) residents present. The facility is a one story home with (4) resident bedrooms and (2) bathrooms. No pools or firearms are housed at the facility. The facility is approved for (6) non ambulatory residents, however the facility currently has a pending change of capacity application for retaining a bedridden resident. Therefore, a citation was not issued. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area and passage ways were observed to be free of hazards. LPA observed hygiene supplies for residents, PPE, clean linens. There are designated locked areas for sharps, dangerous objects, cleaning supplies, and medications. The smoke detector and carbon monoxide are operational, and the hot water temperature 115.8F. There are emergency supplies such as emergency lighting, complete first aide kit and emergency food and water. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed the facility's emergency and disaster plan and infectious control plan. LPA reviewed documentation showing the facility's last fire drill 8/15/2024, which met the department requirements. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate. LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (6) client files were reviewed, and possessed all required paperwork. (1) client's personal and incidental funds are being handled by the facility. Funds and ledgers were reviewed and accounted for. LPA observed resident medications which are locked, filled, and stored in their originally received containers. The medication was accounted for on Centrally Stored Medication logs for residents. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Plan of Correction (POC) Visit. LPA met with Licensee, Fidelia Diaz who was informed of the purpose of the visit. LPA conducted a walk through, interviews, and records review in order to verify completion of POC’s. The following deficiency were corrected by the time of the visit. POC was cleared: Deficiency cited under Title 22 section 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities for the facility not being staffed sufficiently at night from 8pm to 6am to meet night supervision and evacuation needs of residents in care. The POC was to submit an LIC500 showing staffing at night and update the LIC610E to reflecting staffing and evacuation by POC due date of 08/26/2025. During today's visit LPA reviewed the update LIC500 and the updated LIC610E which met the POC. Therefore, the POC was cleared and met at the time of the visit. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 9, 2025

Allegation investigated: Facility has insufficient staffing to meet the needs of the residents Licensee does not have an appropriate emergency disaster plan

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Fidelia Diaz, who was informed of the purpose of the visit. During the visit, LPA conducted interviews and records review. It was alleged “Facility has insufficient staffing to meet the needs of the residents”. It was alleged that there is only (1) staff present at a time, and that there is no awake staff to assist residents at night from 8pm to 6am. LPA reviewed the Preplacement Appraisal for all (6) residents which revealed (2) residents require night supervision. LPA reviewed the care plans for all resident which revealed (2) residents need incontinence care and repositioning. Substantiated LPA conducted (2) staff interviews which revealed there is (1) staff on call at night from 8pm to 6am and wait times for assistance are around (5) minutes. All staff interviewed revealed night staff is asleep at night, and all residents are able to verbalize their needs and call when assistance is needed in between checks. All staff interviewed revealed (2) residents require checks at night for incontinence care and turning every (2) hours. LPA conducted (6) resident interviews. All residents interviewed revealed there is (1) staff member at the facility on call at night from 8pm to 6am and residents need to call for assistance. (4) of (6) residents revealed staff come and check on residents and change and turn R1 and R2 at night with reported wait times of (3) to (10) minutes. (1) of (6) residents, stated staff responds fifty percent of the time at night, and reported waiting (30) minutes for assistance. (1) of (6) residents revealed they do not call for help at night. Therefore, based on pre-placement appraisal of night supervision needed for (2) residents, and the staff and resident statements that the only staff present is asleep and on call at night the allegation that the facility is insufficiently staffed to meet the needs of the residents is substantiated. It was alleged “Licensee does not have an appropriate emergency disaster plan”. It was alleged that there is not enough staff to assist residents in case of an emergency. LPA reviewed the Emergency and Disaster Plan LIC610E, listing the emergency agencies that will be contacted to assist with evacuation, and that staff from all shifts will be called to assist in evacuating and transporting residents. LPA conducted (2) staff interviews and (6) resident interviews revealing there is (1) staff present who is allowed to sleep from 8pm to 6am. All staff interviewed stated there is enough staff available to evacuate residents to safety with (1) staff on the premises and (3) staff on call in the vicinity to assist. LPA reviewed all resident LIC602 Physician's Reports revealing their ambulatory status and ability to transfer. (5) of (6) residents are non-ambulatory while (1) of (6) residents is bedridden. (6) resident interviews and (2) staff interviews revealed the bedridden resident requires total assistance when evacuating, (2) non ambulatory residents require assistance to get into and be pushed in their wheelchairs, while (3) non ambulatory residents have assistive devices they can access on their own and can evacuate on their own in case of an emergency. Therefore, based on resident ambulatory statuses and resident and staff interviews the allegation that the facility does not have an appropriate emergency and disaster plan is substantiated. Based on (1) staff being on call on the premises and (3) residents requiring assistance to evacuate in case of an emergency. The preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations Title 22 is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, Aug 19, 2025 · control 18-AS-20250523161729

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Aug 26, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition to the rights listed in Section 87468.1…elderly shall have all of the following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers…to meet their needs. This requirement was not met as evidenced by: Based on interviews and records review, the facility is not staffed sufficiently at night from 8pm to 6am to meet night supervision needs documented for residents. Based on resident ambulatory status and ability to evacuate in an emergency, the facility is also not sufficiently staffed to evacuate (3) residents who require total assistance with (1) on call staff on the premises. This poses a potential health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: The licensee agreed to submit an LIC500 showing staffing at night and for emergency assistance. The licensee agreed to update their LIC610E plan to reflecting staffing and evacuation level. The licensee also agreed to submit a written procedure for staff on how residents needs for turing and repositioning will be met at night.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Janira Arreola conducted an unannounced visit to the facility in order to conduct case management deficiency visit. The LPA met with Licensee, Fidelia Diaz, who was informed of the purpose of the visit. LPA conducted interviews with all residents and records review of all resident. Based on observation of Resident #1 (R1), interview with R1, interview with (1) staff, and record review of R1’s care plan and LIC602 Physician’s Report, R1 is deemed bedridden. R1 is unable to turn in bed and unable to transfer in and out of bed without staff assistance. The current approval for the facility is for non ambulatory residents only. Therefore, the facility is being cited for having (1) bedridden resident. A immediate civil penalty was assessed for $500. A plan of correction was created and met at the time of the visit. An exit interview was conducted where this report was reviewed and provided along with deficiency page, civil penalty page and appeal rights.the state’s words, verbatim · CDSS document, Aug 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Aug 19, 2025

(a) All facilities shall maintain a fire clearance approved by the…fire department, or district…or…Fire Marshal. Prior to accepting or retaining any of the following types of persons, the…licensee shall notify the licensing agency and obtain an appropriate fire clearance approved….(2) Bedridden persons This requirement was not met as evidenced by: Based on observation, interview, and record review R1 is bedridden and the facility does not have approval from the local fire jurisdiction. This poses an immediate health safety or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Aug 19, 2025

Plan of correction: The licensee called their local fire department during the visit and informed them of the bedridden resident. The licensee provided proof of submitting a fire clearance request to the department at the time of the visit. LPA confirmed the request was received 08/18/2025.

Allegation investigated: Staff do not allow resident to refuse medication. Staff locked residents in care for an extended period of time. Staff do not provide adequate meals to residents in care.

On October 18, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with Administrator, Fedelia B. Daiz. The visit was conducted to deliver findings for the listed allegations. During the investigation, LPA interviewed staff, residents, and witness, conducted record reviews, and made observations regarding the list allegations. LPA was unable to interview Resident 1 (R1) due to R1 relocating to another facility. On May 23, 2024, Community Care Licensing received a complaint alleging staff do not allow resident to refuse medication, staff locked residents in care for an extended period, and staff do not provide adequate meals to residents in care. Further information reported that residents are given medication they are not familiar with. It was also reported that the facility did not have adequate utilities such as inoperable ceiling lights and fans, inoperable electrical outlets, inoperable boiler, and oven in kitchen areas. Unsubstantiated Regarding the allegation staff do not allow resident to refuse medication, three of five staff were interviewed. Three of five staff interviewed revealed R1 would put up a fuss and refuse to take prescribed medication and although R1 would initially refuse, staff would encourage R1 to take their medication and R1 would then oblige without force. Additional interviews with residents indicated they have not missed their medications. The residents did not observe the staff force any of the residents or not allow any of the residents to refuse their medications. Residents indicated they were not forced or did not refuse their medications. Regarding the allegation staff locked residents in care for an extended period. Interview with Staff Number 2 (S2) indicated there was never a time when any staff left any residents, requiring assistance, unattended or locked them up. Additional interviews with staff corroborated the statements. Information received from interviews with residents corroborated the statements that at no time where residents locked in or unattended to. Regarding the allegation staff do not provide adequate meals to residents in care, information obtained from resident interviews three of five residents three of the three interviewed, 3 of 5 advised the facility provided home cooked meals. Interviews with residents also indicated there were no concerns regarding the type or amount of food provided by the facility. Interviews with staff indicated there has not been a time any of the residents have requested more food and were denied food. A review of the records including menus and grocery shopping receipts demonstrated grocery shopping is completed on a weekly basis and the items on the menu match the food available at the facility. Information obtained from interviews with the administrator stated residents can select the types of food to add to the menu. Additionally, information obtained from resident interviews stated residents have food items of their choice. Based on information obtained from interviews, record reviews, observation, and the inability to obtain information from pertinent parties there is not a preponderance of evidence to prove the alleged violations occurred. Therefore, the allegations are deemed as unsubstantiated. An exit interview was conducted, and a copy of this report was provided and given to Administrator, Fedelia B. Daiz. Administrator stated they were not aware or advised of any outlets, fans, or appliances not working. Information obtained from a third-party witness indicated during their visits, they did not observe any issues with the electricity or appliances. On May 24, 2024, and September 19. 2024, LPAs conducted a facility inspection and observed the kitchen appliances, ceiling fans, and outlets to be operable. Based on information obtained from interviews, record reviews, and observations, the information obtained was not sufficient to demonstrate the listed allegations were valid. Therefore, the allegation has been deemed as unfounded. An allegation deemed unfounded means the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was discussed and given to Administrator, Fedelia B. Daiz.the state’s words, verbatim · CDSS document, Oct 18, 2024 · control 18-AS-20240523103450

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Debbie Palacios and Sara Martinez made an unannounced visit to the facility to conduct a 1 year required inspection. LPAs were greeted and Licensee Fedelia Daiz provided the facility tour. LPAs conducted a tour of the interior and The facility is a single story home consisting of 4 bedrooms, 2 bathrooms, kitchen, living room, and 1 staff room. The facility was observed to be clean, clutter, and free from obstructions in the passageways. LPAs observed a hand rail in a hallway leading to a Resident's room to be hanging off from the wall which is a potential health and safety risk for residents in care. A deficiency will be issued under Title 22 Regulation 87303(a) along with a plan of corrections. The facility was observed to have personal protective equipment (PPE) supplies. There are no known guns or ammunition on the premises. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. The facility has a record of emergency disaster drills being conducted but last emergency drill conducted was on 05/16/2024 which it does not meet Department requirements.Deficiency cited under Health and Safety Code 1569.695(c) along with the plan of corrections. Detergents, cleaning solutions, and sharp and dangerous objects were observed to be unlocked and were accessible to residents which is a potential health and safety risk for residents in care. A deficiency will be issued under Title 22 Regulation 87309(a). LPAs observed that the facility had expired food in the refrigerator and in pantry; a deficiency will be issued under Title 22 regulation 87555(b)(8). LPAs reviewed staff files and training. All staff have the required personnel records on file and criminal record clearance. LPAs observed that staff (1) did not have the required Annual training. A deficiency will issued under Health and Safety regulation 1569.625(b)(2).Three (3) resident files were reviewed and possessed all required paperwork which included Admissions Agreement, Needs and Service Plan, and updated Physician's Report. The listed administrator possesses a current administrator's certificate that expires in 2025. Resident medication was centrally stored and locked in a medication cabinet located in the kitchen. LPAs reviewed medications prescribed to three (3) residents and found all medication with required labeling found to be in place. LPAs observed Resident one (R1) had PRN administered without required documentation of day and time given. A Deficiency will be issued under Title 22 regulation 87465(d)(3). LPAs reviewed the facility's emergency and disaster plan. Based on today's visit citations were issued on the attached 809D, in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report, appeal rights, LIC 811 were provided to Fedelia Daiz, Licensee.the state’s words, verbatim · CDSS document, Oct 2, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA ) Yolanda Delgado conducted a case management visit during a visit and observed two (2) staff and four (4) residents in care. LPA toured the facility and observed bathroom #1 sink water pressure was low and the shower attachment is not working properly. Food supply was observed and there is sufficient food supply. One deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted with Fedelia Daiz and a copy of this report, 809-D and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Mar 26, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(6) · Plan of correction due date: Apr 9, 2024

MAINTENANCE AND OPERATIONS: (e) Water supplies and plumbing fixtures shall be maintained as follows: (6)...bathing facilities shall be maintained in operating condition...based on the residents' needs. This requirement is not being met as evidenced by: LPA observed the sink pressure very low and shower attachment water pressure is extremly low and a knob is used to turn on and off at the top, bath knobs are not working. This poses a potential health and safety risk to the clients in care.the state’s words, verbatim · CDSS document, Mar 26, 2024

Plan of correction: Licensee will repair and send copy of invoice to LPA by POC Due date.