Agate Home Care

Type of visit: Prelicensing

Licensing Program Analyst (LPA) LaVette Farlow, arrived at Agate Home Care, to conduct an announced Pre-Licensing visit for licensure. LPA was greeted by Administrator Rainer Delfin, and Karen Bustillos, Licensee. LPA introduced self and stated purpose of the visit. LIC200 application was submitted on 02/07/2025 for six (6) bed capacity, (5) non-ambulatory, and (1) bedridden resident. Fire Safety Inspection clearance was granted for (5) non-ambulatory residents, and (1) bedridden resident on 07/21/2025. LPA toured the facility inside and outside and observed the following: Structure: Facility is a one story house with (4) resident bedrooms, (2) resident bathrooms, 1 office/staff area with a bathroom, extra room attached to the garage used as a storage space, living room, dining area, kitchen, pantry, backyard, and attached garage. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Two bedrooms accommodates two non-ambulatory residents in each room, and two bedrooms accommodates one non-ambulatory private which room number four (4) is for a bedridden resident. Bathrooms: The resident bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives, sharps, detergent, and chemicals are stored in locked cabinets. There was a pantry stocked with non-perishable food and perishable food found in the refrigerator. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Water tested in the bathroom and kitchen faucet measured at 93.9 and 94.3 degrees Fahrenheit. Administrator Rainier adjusted the water level and the water measure 122.3 and 124.2. LPA advised Administrator to monitor the water level and consider purchasing "caution hot water" signs to be posted. LPA observed a functional washer and dryer are located outside across from the garage in a closed room. Living/Family room: There was a furnished living room with reading material and a TV observed. Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies stored in a closet. Yards/Outside: A self-latching handle gate on the left and right side of the house that leads into the backyard. There are no firearms, ammunition, swimming pool or bodies of water observed. LPA observed an additional room attached to the garage currently used as storage. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch, visiting rules, and personal rights were observed posted by the entrance. LPA observed the Licensee has an operational phone line 909-204-2454, for residents in care. General items: The smoke and carbon monoxide detectors were tested and are operable. There was a fully charged fire extinguishers observed. Resident/Staff records storage space for filing. First Aid kit with required components, and a locked area for medication storage was observed. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22. Based on the observations and evaluation of the facility this date, the facility is ready for licensure. LPA completed COMP III with the Licensee at the conclusion of the inspection. Licensee will be notified once facility is licensed. An exit interview was conducted, and this report was discussed and provided to Administrator Rainier Delfin and Karen Bustillo, Licensee.the state’s words, verbatim · CDSS document, Feb 9, 2026