Angelic Mansions

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Facility Administrator Steven Rajadas and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (15) current census (9). LPA was accompanied by Facility Administrator, 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 client 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 temperatures in the bathrooms to be at 105.8 degrees F 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 clients in care. There was a designated storage space for client/staff files. Medications are kept inside laundry room cabinets inaccessible to clients. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed five (5) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. 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 Facility Administrator Steven Rajadas.the state’s words, verbatim · CDSS document, Oct 4, 2023

Allegation investigated: Staff did not provide adequate laundry service to resident Staff did not provide food in the quantity necessary to meet resident's needs

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a complaint investigation. LPA met with Steven Rajadas, Administrator and discussed the purpose of the visit. The investigation consisted of LPA observations, interviews, and document review. Regarding the allegation staff did not provide adequate laundry service to resident, Administrator and staff interviews deny that staff is not providing adequate laundry service to residents in care. Six (6) out of seven (7) residents interviewed stated that the facility does provided adequated laundry service. Regarding the allegation staff did not provide food in the quantity necessary to meet resident's needs, Administrator and staff interviews deny not providing enough food for residents in care. Unsubstantiated Administrator stated that the facility provides residents with breakfast, lunch, dinner and snacks. All seven (7) residents interviewed stated that the facility is providing enough food to meet their needs. LPA toured the kitchen and food storage areas. The facility has a sufficient supply of perishable and non-perishable food items for residents in care. Based on LPA observations, interviews and document review, the allegations are Unsubtantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy with appeal rights was provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 14, 2023 · control 56-AS-20230811083437

Allegation investigated: Facility has an infestation of cockroaches. Facility does not have hot water. Resident(s) not being fed a sufficient amout of food. Residents have access to toxic materials while in care. Residents have access to sharp objects while in care. Centrally stored medications are not kept in a safe and locked place.

Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility for the purpose of initiating an investigation and delivering findings for the above complaint allegations. LPA Gardner met with Administrator Steven Rajadas and explained the reason for the visit. At the time of the visit there were eleven (11) residents, and three (3) staff present. During today’s visit, LPA Gardner toured the facility, interviewed staff members, interviewed residents, and reviewed facility records. For allegation, Facility has an infestation of cockroaches. LPA Gardner observed cockroaches in the hallway and in the living room area near a hole in the wall. Substantiated For allegation, Facility does not have hot water. LPA Gardner measured the water temperature in the bathroom at 102.5 degrees Fahrenheit. The water temperature in the bathroom is below the requirement of 105 degrees Fahrenheit. For allegation, Resident(s) not being fed a sufficient amount of food. LPA Gardner was informed by the Administrator that the facility restricts food in between meals. If a resident requests food in between meals, the resident is told they need to wait until the next mealtime or snack time. The residents in care do not have limited dietary restrictions prescribed by a physician. For allegation, Residents have access to toxic materials while in care. LPA Gardner found unlocked chemicals in the cabinet underneath the kitchen sink. For allegation, Residents have access to sharp objects while in care. LPA Gardner found that knives were placed inside the kitchen pantry in an unlocked cabinet. There was also a knife left in a dish strainer on the kitchen counter. For allegation, Centrally stored medications are not kept in a safe and locked place. LPA Gardner found that medication was placed inside the kitchen pantry in an unlocked cabinet. Based on the information found and provided, the six (6) allegations listed above are deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. During today’s visit, six (6) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Administrator Steven Rajadas, along with a copy of the appeal rights. For allegation, Resident's diapering needs are not being met. LPA Gardner found that the resident’s diapering needs are being met based on interviews with residents and staff. Based on the information found and provided the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. 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 was discussed and provided to Administrator Steven Rajadas, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jul 1, 2022 · control 56-AS-20220628152115

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jul 2, 2022

87303.Maintenance and Operation. (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not met based on evidence by observation. LPA measured the water temperature in the bathroom sink at 102.5 degrees Fahrenheit.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87303 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed to adjust the facility water heater to meet the requirement of 105-120 degrees Fahrenheit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(3) · Plan of correction due date: Jul 2, 2022

87555. General Food Service Requirements. (b)The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This requirement was not met based on evidence by interview of the Administrator. LPA was informed by the Administrator that the facility restricts food in between meals. If a resident requests food in between meals, they are told they need to wait until the next mealtime or snack time.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87555 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed to allow residents food in between meals unless there is a dietary restriction prescribed by a physician.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Jul 2, 2022

87705. Care of Persons with Dementia. (f)The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met based on evidence of observation. LPA observed an unlocked cabinet underneath the kitchen sink with toxic chemicals accessible to residents. LPA observed bleach and raid.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87705 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed store toxic chemicals in a locked area that is inaccessible to residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jul 2, 2022

87465. Incidental Medical and Dental Care. (h)The following requirements shall apply to medications which are centrally stored: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met based on evidence of observation. LPA observed an unlocked cabinet in the kitchen pantry with medication accessible to residents.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87465 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed store medications in a locked area that is inaccessible to residents.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(1) · Plan of correction due date: Jul 2, 2022

87705.Care of Persons with Dementia.(f)The following shall be stored inaccessible to residents with dementia: (1)Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement was not met based on evidence of observation. LPA observed an unlocked cabinet in the kitchen pantry with sharp knives accessible to residents.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87705 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed store sharp knives in a locked area that is inaccessible to residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 8, 2022

87303. Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met based on evidence by observation. LPA found cockroaches in the hallway and in the living room, as well as a hole in the wall in the living room.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87303 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed send LPA an action plan of how they plan to correct the hole in the wall, as well as pictures of the corrected hole in the wall. The licensee has agreed to send LPA statement proof of cockroach exterminator visits to LPA.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility for complaint control number 56-AS-20220628152115. During the complaint visit, LPA Gardner completed a case management visit to cite for deficiencies found during the complaint visit. LPA Gardner met with Administrator Steven Rajadas and explained the reason for the visit. At the time of the visit there were eleven (11) residents, and three (3) staff present. During today’s visit, LPA Gardner found that the facility is using a condom catheter on resident (R1) overnight while the resident sleeps. The staff in the facility are placing the condom catheter on R1 prior to bedtime. The facility does not have does not have a physician’s order from hospice for the use of the condom catheter. The facility is also not qualified to place the condom catheter on R1. LPA Gardner also found that Staff S1 has been working in the facility for two (2) months without obtaining a criminal background clearance. The facility will be receiving a citation and a $500-dollar civil penalty for allowing S1 to work in the facility without proper clearance. 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 was discussed and provided to Administrator Steven Rajadas, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jul 1, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 2, 2022

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 or a criminal record exemption as required by the Department or This requirement was not met based on evidence of observation and interview. LPA was informed that S1 has been working at the facility for two (2) months without a criminal background clearance.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87623(a)(B) · Plan of correction due date: Jul 2, 2022

87623.Indwelling Urinary Catheter. (a)The licensee shall be permitted to accept or retain a resident who requires the use of an indwelling catheter under the following circumstances: (B) A catheter shall only be inserted and removed by an appropriately skilled professional under physician's orders. This requirement was not met based on evidence of observation and interview. LPA was shown the condom catheter in the resident’s bedroom closet. The Administrator admitted that staff puts the condom catheter on the resident at bedtime.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The licensee has agreed to read regulation 87623 entirely and send LPA self-certify letter that the regulation was read and understood. The license has agreed that staff will stop the use of condom catheter. A catheter shall only be inserted and removed by an appropriately skilled professional under physician's orders.

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 annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Gardner met with Administrator Steven Rajadas who confirmed that there are currently no cases/exposures of COVID-19 within the facility. At the time of visit there were three (3) staff and thirteen (13) residents present. LPA Gardner went over COVID-19 best practices for infection control and prevention with Steven Rajadas. The residents have hand sanitizer available to them and the bathrooms were stocked with hand soap and paper towels. LPA Gardner observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, and social distancing. The facility has a designated infection control person who is responsible for ensuring that the facility is compliance with infection control practices. LPA Gardner requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the bathroom cabinet. The facility has a limited supply of PPE. The facility was notified that they need to obtain a full 30-day supply of PPE items such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer. LPA Gardner inquired as to if staff have been fit tested for N95 masks and was told their staff have not been fit tested yet. LPA Gardner will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks and for not having a full thirty (30) day supply of PPE. All residents and staff are practicing all other COVID-19 precautions, which minimize the risk of them contracting COVID-19. During today’s visit it was found that staff (S1) does not have a criminal record clearance. S1 has been working at the facility for three (3) months. The facility will be issued a citation and a $500-dollar civil penalty for allowing S1 to work at the facility without a criminal record clearance. Based on the observations made during today’s visit, one (1) type A deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Steven Rajadas, along with a copy of the TA Advisory Note, LIC809D, LIC811, LIC421BG, and the appeal rights.the state’s words, verbatim · CDSS document, May 13, 2022

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Resident fell while in care. Resident left on floor for extended period of time Resident not provided comfortable temperature. Facility is in disrepair.

Licensing Program Analyst (LPA) Javina George made an unannounced visit to commence a complaint investigation as well as to deliver findings for the allegation(s) listed above. LPA met with Administrator's Phillip and Steven Rajadas and explained the purpose of the visit. Allegation: Resident fell while in care. LPA conducted interviews with Administrators Steve and Phillip Rajadas and it was confirmed that Resident #1 did have a fall on the weekend. Steven explained that the call system was temporarily not working and that staff was given the directive to check on the outside residents every 20-30 minutes. Per Administrator Staff #1 (S1) states that they did as they were told and that, when they went in to check on resident that they were laying on the floor. LPA reviewed communication logs that document R1 fell on 7/25/21, and had a bump and small laceration on the back of their head. R1 was recently moved to a different room following the incident, to keep an additional eye on R1. The allegation of Resident fell while in care is SUBSTANTIATED. Substantiated LPA observed multiple times throughout LPA's visit other resident's pressing their call buttons and staff responding. The allegation of Resident's call button does not work is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report, was provided to Administrator's Phillip & Steven Rajadas. Allegation: Resident left on floor for extended period of time. On 7/25/21 R1 sustained a fall where there was a bump, and laceration that was not bleeding on the back of R1's head. Steven explained that the call system was temporarily not working and that staff was given the directive to check on the outside perimeter residents every 20-30 minutes. Steven stated "to be honest that there is no way to tell how long R1 was left on the floor." There is an entry in the communication logs that revealed Staff #1 (S1), whom was on shift at the time of the fall, and made an entry reporting the incident however, the entry is vague and does not match with what was reported. Additionally in the communication logs reviewed in a different entry it states that R1 stated that they were on the floor calling for help for awhile. The allegation of Resident left on floor for extended period of time is SUBSTANTIATED. Allegation: Resident not provided comfortable temperature. LPA conducted a tour of the physical plant. LPA observed that the facility has three separate cooling systems, one for each side of the home. The thermostat where Resident #1 (R1) room is (left side, facing standing at the front door), revealed that it was 79 degrees inside, the current outside temperature at the time of the visit was 98 degrees. LPA did observe a ceiling fan that was not in use in R1s room. LPA conducted interviews and R1 stated that yes at times it does get warm inside of their room. Based on observation and interviews the allegation of Resident not provided comfortable temperature is SUBSTANTIATED. Allegation: Facility is in disrepair LPA conducted a tour of the physical plant and observed there to be old Christmas lights still hung, and one of the string of lights hanging down in the front of the facility. Also in the front entrance there were boxes on the table and patio furniture, bunched together. LPA observed in the backyard to certain areas of clutter: wheelchair, several boxes, trash cans, dolly, buckets, storage containers, and cat trees stacked in the backyard, up against the fence and the wall. Therefore the allegation of Facility is in disrepair is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted and a copy of this report, and appeal rights were provided to Administrator Steven Rajadas.the state’s words, verbatim · CDSS document, Aug 2, 2021 · control 18-AS-20210727134026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(6) · Plan of correction due date: Aug 3, 2021

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on observation interview and record review the licensee failed to provide adequate care and supervision 1 out of 1 time. This poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 2, 2021

Plan of correction: The licensee agrees to relocate R1 so that staff can provide adequate care and supervision. The room change has already been made, nothing futher is needed.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(10) · Plan of correction due date: Aug 16, 2021

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (10)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental abuse... Based on observation, interview and record review the licensee did not ensure that R1 was not neglected 1 out of 1 times. This poses a potential health, safety and person rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 2, 2021

Plan of correction: The licensee agrees to conduct an in-service on care and supervision. Proof is to be submitted to the department by 5pm, on the due date indicated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b)(2) · Plan of correction due date: Aug 16, 2021

87303 Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. Based on observation, interview and record review the licensee did not ensure that the facility was kept at a comfortable temperature 1 out of 1 times. This poses a potential health, safety and person rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 2, 2021

Plan of correction: The licensee agrees to conduct an in-service on heat induced illnesses and submit proof to the department by 5pm on the due date indicated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(c) · Plan of correction due date: Aug 16, 2021

80087 Buildings and Grounds (c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction. Based on observation, interview and record review the licensee did not ensure that the facility was free from obstruction 1 out of 1 times. This poses a potential health, safety and person rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 2, 2021

Plan of correction: The licensee agrees to move the items to one of the 3 storage sheds on the property by 5pm on submit proof by virtual visit by the due date. Licensee will cotnact LPA by 5pm.