Angels Home for Seniors

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. LPA Valerio was met by facility staff Luis, and explained the purpose of the visit. LPA was later met by Administrator Deane Jeffrey Dejaresco. LPA Valerio observed two (2) staff on shift and six (6) residents in care. Staff were observed assisting residents with breakfast, morning ADLs, cleaning, and prompts to drink water. LPA Valerio observed the common areas of the facility to be fully furnished, clean, and free from hazardous items. LPA Valerio observed the kitchen area, where the sharps and medications were observed to be locked and inaccessible to residents in care. Residents bedrooms were clean and free from odors. Resident bathrooms were observed to be sanitary. Hot water was measured within the 105.0 - 120.0 degree F. The temperature inside the home was observed to be set at comfortable temperature. LPA Valerio observed the facility food supply. A technical advisory was given for the emergency food supply, as it was not enough for 6 residents and two staff members. The daily food supply was observed to be adequate. The garage was observed to be utilized for storage and have an area for staff breaks. The exterior area was observed. The facility replaced a section of the fence in the backyard. LPA Valerio observed three (3) staff files and two (2) resident files. Resident files were observed to be up to date with required documentation. The administrator is waiting on R1's responsible party to sign the updated reappraisal and other updated documents. Staff files were observed to be complete with required annual training. LPA Valerio requested the following: LIC 500, LIC 308, LIC 309, LIC 610E, and Liability Insurance. A Technical Advisory was issued today. No deficiencies were cited. An exit interview was held, and a copy of this report was provided to the administrator.the state’s words, verbatim · CDSS document, Jan 2, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Administrator Deane Jeffrey Dejaresco, and explained the purpose of the visit. LPA Valerio observed two staff on shift and six residents present in the facility. LPA Valerio and Administrator toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed six resident bedrooms. Resident bedrooms were observed to be clean, free from debris, fully furnished, and free from odors of incontinence. Resident bathrooms were observed to be sanitary and fully stocked with hygiene supplies. Residents were observed to be watching television in their rooms, taking a nap, or having a visit with family. Staff were observed to be assisting residents with walking, activities of daily living, providing meals/drinks, completing laundry, and watching a movie with the residents. The facility was observed the facility heating/air conditioning, fire extinguisher(s), carbon monoxide detectors, and door alarms to be in working condition. The kitchen and common areas were observed to be fully furnished, organized, and clean. The backyard was observed to be fully furnished and had areas for outdoor visitation. No health or safety concerns were observed during today's visit. LPA Valerio reminded Administrator to send the following annual documentation by 01/30/2025 to (916) 263 - 4747 or LPA Valerio: LIC500 – Personnel Report, LIC308 – Designation of Administrative Responsibility, LIC309 – Administration Organization, LIC610E – Emergency Disaster Plan, and copy of updated Liability Insurance Certificate. Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited on today's visit. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit. LPA Valerio met with Facility Staff Kyle , and explained the purpose of the visit. On 08/07/2024, The Regional Office received notification that the facility has 6 - 8 individuals living inside the facility and it was alleged that staff may be living in the garage. LPA Valerio and facility staff Kyle inspected the physical plant to ensure compliance with Title 22 regulations. LPA observed 6 bedrooms and counted 6 residents in care and 2 staff present. According to staff interviews, there is no live in care staff. LPA observed the backyard to have no outdoor storage room. LPA observed the garage. LPA observed a staff break area next to the storage area/car area. According to staff, this is utilize for staff break time during the day or night. LPA Valerio contacted Administrator Deane Jeffrey Dejaresco and explained the purpose of the visit. LPA Valerio and Administrator Deane discussed the staff break room. LPA requested an updated copy of the facility sketch be sent to LPA by 08/22/2024. Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited today. An exit interview was held, and copy of the report was provided to facility staff.the state’s words, verbatim · CDSS document, Aug 8, 2024

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a post-licensing inspection. LPA was met by facility staff Kyle Arneta, and explained the purpose of the visit. LPA was later met by Administrator Deane Jeffrey Dejaresco. LPA Valerio toured the facility to ensure compliance with Title 22 regulations. LPA Valerio observed 6 residents and 2 staff present in the facility. LPA Valerio observed the common living room area, kitchen area, garage, resident bedrooms, resident bathrooms, exterior area, and laundry room area. Common areas were observed to be free from debris and free from odors. Resident bedrooms were fully furnished with no obstruction of emergency exits. Resident bathrooms were fully stocked with paper towels, toilet paper, soap, a trash can, and hygiene supplies. Garage area was observed to be utilized for storage only. Backyard area was furnished with a seating area. The facility was observed to have an adequate supply of food. Medications, sharps, and cleaning supplies were observed to be locked and inaccessible to residents in care. LPA spoke to staff and residents during the visit. Staff were assisting residents with ADLs and assisting with a visit. Residents were observed watching television, walking around the home, and inside their bedroom. LPA Valerio reviewed 2 staff and 2 resident files. Files were observed to be complete and up to date. Administrator informed LPA Valerio that the licensee would like to install cameras for the common areas of the facility and exit door ways. LPA Valerio provided guidance to administrator/licensee regarding procedures and documentation needed for video surveillance. Administrator to submit required documentation to LPA Valerio via fax or email. Per California Code of Regulations (CCR) Title 22, no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 16, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a Pre-Licensing Inspection. LPA met with Deane Jeffrey Dejaresco, and explained the purpose of the visit. The facility currently has residents in care due to undergoing a Change of Ownership from Blessed Home for Seniors III (#342700307) to Angels Home for Seniors LLC (#342701360). The facility is an Residential Care for the Elderly and is licensed to provide services for six (6) individuals, of which 5 may be considered non-ambulatory and 1 may be considered bedridden. A resident considered bedridden may only be permitted to reside in room #6. Residents considered non-ambulatory may only be permitted to reside in rooms #1, #2, #3, #4, and #5. According to the Plan of Operations, the facility has a current Dementia Care Plan on file. LPA Valerio and Administrator Deane toured the facility to ensure compliance with Title 22 regulations. LPA inspected the kitchen area, pantry closet, common areas, resident bedrooms (6), resident bathrooms, laundry area, garage area, and exterior plant. The kitchen was observed to be clean and free from debris. Staff were observed cooking breakfast, assisting with resident meals, and preparing residents for a visitor. Sharps and knives were located in a cabinet under the sink, which was observed to be locked. The refrigerator and freezer were stocked with a food supply to meet Title 22 requirements. The pantry was stocked with dry goods and non-perishable food items. Common areas, such as the living room space, dinning room, and hallways were observed to be clean, fully furnished, and free from hazards. Six resident bedrooms were inspected. Resident rooms were observed to be free from odors, had necessary furniture in good condition, and free from any obstructions of emergency exits. Residents were observed sleeping, eating, sitting in the living, and visiting with a visitor. Continues on LIC 809 - C... ...Continued from LIC 809 Resident bathrooms were equipped with hand towels, toilet paper, skid mats, ADA compliant hand rails, trash cans, hand soap, and hand sanitizer. Bathroom fixtures were observed to be in good repair. The hot water was measured in the resident bathroom sink. LPA observed the hot water to be at a temperature of 106.0 degrees Fahrenheit, which is within the required range of 105.0 - 120.0 degrees F. The laundry area was equipped with a washing machine and a dryer. Cleaning supplies were observed to be locked and inaccessible to residents in care. The facility was observed to have a first aid kit, emergency supply of food, emergency supplies, an extra supply of linen and comforters, an extra supply of towels. LPA observed the garage area. The garage is inaccessible to residents in care. The garage will be used for storage and has a back up refrigerator and freezer. The refrigerator located in the fridge will primarily be used for staff food; however, excess resident foods can be placed in the fridge. The exterior plant was observed. The facility has a large backyard area with a cemented area that can be utilized for outdoor visits or outdoor activities. LPA observed a sitting area, a gardening area, and an emergency walk way. LPA observed the walk way to be free from obstructions. The gate leading to the outside was observed to be in working condition and able to open/close. LPA reviewed two (2) staff files and two (2) resident files. LPA observed files to be complete with required documents. The facility was observed to have necessary signage posted along the walls of the facility. LPA requested the following documentation to be sent to LPA Valerio once completed: Updated LIC 610E, updated LIC 500, updated LIC 308, and updated Liability Insurance The administrator was information that the pre-Licensing inspection is complete and no deficiencies were observed. Component III was completed with the licensee and there are no further questions. LPA Valerio will notify the Regional Office and Applications Analyst of the completion by close of business 01/19/2024. An exit interview was held, and a copy of the report was provided to Administrator Deane.the state’s words, verbatim · CDSS document, Jan 19, 2024