The Velasco Homes #5

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Demetria Mangoba (S1). During the visit, Caregiver Teresa Legaspi (S2) arrived at the facility. S2 had a current criminal record clearance; however, S2 was not associated with the facility in Guardian. During the visit, Backup Administrator Elizabeth Velasco arrived at the facility to assist staff in meeting the residents’ needs. According to the facility’s license, the facility has a maximum capacity of six (6) residents. Residents may be ambulatory or non-ambulatory; however, no residents may be bedridden. At the time of today’s inspection, the facility had six (6) residents in its census. Four (4) residents were physically present at the facility, and two (2) resident were temporarily out of the facility. Of the six (6) residents, two (2) were ambulatory. None of the residents were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither type of door was observed at the facility. LPA, accompanied by facility staff, toured the interior and exterior of the facility and inspected the common areas and resident bedrooms. During the inspection, R1 sustained a fall while attempting to transfer from a recliner to a walker. LPA observed that S1 was unable to assist R1 from the floor. S1 telephoned facility management and other staff members to request assistance. S2 arrived at the facility approximately one hour later. S1 and S2 attempted to assist R1 from the floor but were initially unsuccessful. R1 remained on the floor for approximately two hours. (Page 1 of 3 continue at LIC809C) (Continue from LIC809) R1 subsequently regained sufficient strength to get from the floor to the bed with assistance from S1 and S2. LPA did not observe any apparent injury to R1 following the fall. Following the incident, R1 remained in bed for approximately two hours. R1 was subsequently observed transferring from the bed to the desk and then to the living room. R1 remained seated on the couch listening to music for two hours and then R1 was observed sitting in their recliner in his room. LPA confirmed with R1 no feeling any pain or discomfort. During the facility tour, the facility was observed to be clean, sanitary, and in good repair. Pathways were free of obstructions and apparent trip hazards. One resident bedroom had a strong odor of urine, and the resident’s bed did not have linens. Resident bedrooms contained the required furnishings. Doors, windows, and screens, toilets, and showers were operational. Extra linens and hygiene supplies were available. The facility had sufficient space and equipment to accommodate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient indoor temperature was measured at 80°F. Hot water temperatures at taps accessible to residents were within the required range. Refrigerators and other appliances used to store perishable food were maintained at compliant temperatures. At least two (2) days of perishable food and at least seven (7) days of nonperishable food were available and safely stored. Cooking and dining equipment and utensils were available. No toxic chemicals, poisons, open-faced heaters, or other hazardous items accessible to residents were observed. Medications were appropriately labeled and stored in locked areas. Carbon monoxide detectors, smoke detectors, night lights, emergency lighting, and the facility telephone were observed to be operational. The facility fire extinguisher had been serviced within the previous twelve (12) months. No fireplaces or pools/bodies of water were observed on the premises. According to the Licensee, no firearms or ammunition are maintained at the facility. Required licensing postings were observed in visible areas of the facility. The Licensee provided proof of current business liability insurance and surety bond. (Page 2 of 3 Continue at LIC809C) (continue from LIC809C) During review of resident records, no deficiencies were identified. Review of personnel records disclosed that current health screenings were not maintained for S1 or S2. Deficiencies were cited pursuant to California Code of Regulations, Title 22, and are documented on the LIC 809-D pages. Civil penalty of $500, as applicable, is documented on the corresponding LIC 421BG. Plans of Correction were developed jointly with Administrator Lailani Velasco and Elizabeth Velasco. An exit interview was conducted with Administrator Elizabeth Velasco. LPA provided the Administrator with a copy of this report, the LIC 809-Ds, LIC421BG, the LIC 811 Confidential Names List, and the Licensee/Appeal Rights during today’s visit. Page 3 of 3the state’s words, verbatim · CDSS document, Sep 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen made an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with House Manager Flavel Catahan. LPA also spoke briefly via phone with Administrator Lailani Velasco. According to the facility’s license, the facility has a maximum capacity for six (6) residents, of whom all may be ambulatory or non-ambulatory, but none may be bedridden. Per LPA observation, LIC602 Physician’s Reports, and staff interviews: During today’s inspection, there were a total of six (6) residents in care, of whom two (2) were ambulatory and four (4) were non-ambulatory, but none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter doors, and neither of these were present. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility and inspected all common areas and resident bedrooms. LPA met with multiple residents and interviewed all staff who were present. LPA reviewed care records for all residents and personnel records for all active staff. During the facility tour, LPA observed: In the facility’s kitchen were eight (8) sharp cooking and/or steak knives unlocked/unsecured. Of these, one (1) had a metal blade over ten inches long, and seven (7) had a metal blade over six inches long. Per facility records, 6 of 6 residents in care [Resident #1 (R1) through Resident #6 (R6)] were diagnosed with significant intellectual disabilities. [See LIC811 Confidential Names List for a description of person identifiers used in this report.] Regulation thus required these knives to be kept in “locked storage” when not in active use by staff. In 4 of 4 bathrooms used by residents, the showers did not have “slip resistant mats, strips, or flooring,” as required. [CONTINUED ON LIC809-C, 1 of 2] [CONTINUED FROM LIC 809] Beyond the above, the facility was clean, sanitary, and in good repair. Pathways were free of obstruction and trip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 74 F. Where tested, hot water temperature at taps accessible to residents were all compliant: Kitchen Sink was 107.2 F, Bathroom #1 Sink was 115.7 F, Bathroom #2 Sink was 111.7 F, Bathroom #3 Sink was 117 F, and Bathroom #4 Sink was 115.2 F. Appliances to preserve perishable food were also compliant in temperature. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons, open-faced heaters, or other hazardous items accessible to residents. Medications were labeled, as required, and stored in locked areas. Carbon monoxide detector, smoke detectors, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher had been serviced within the last twelve (12) months. No fireplaces or pools/bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Required licensing postings were observed in visible areas of the facility. Licensee presented proof of current business liability insurance and surety bond. During review of resident records, LPA observed, and staff interview confirmed: Licensee did not have a copy of a signed Admissions Agreement contract on file for R1, who records show moved into the facility in May 2025. Records showed R2 relocated to this facility in February 2023 from one of Licensee’s other facilities. However, Licensee did not sign a new Admissions Agreement contract with R2 for The Velasco Homes #5, as required. (CCLD considers each facility to be a legally distinct from the other,) For 3 of 6 residents (R2, R3, and R4), Licensee did not maintain a written Absentee Notification Plan as part of their written record of care, as required. [CONTINUED ON LIC 809-C, 2 of 2] [CONTINUED FROM LIC 809-C, 1 of 2] During review of personnel and training records, LPA observed, and staff interview confirmed: Licensee did not maintain at the facility a complete personnel file on themselves, as required. For 7 of 7 direct care staff [Staff #1 (S1) through Staff #7 (S7)], Licensee did not ensure these persons received at least twenty (20) hours of training annually. [Regulation requires at least twenty (20) hours of continuing education/training per year, of which of which eight (8) hours must be on Dementia, and four (4) hours must be on Restricted Health Conditions, Hospice Care, and Postural Supports.] Licensee also did not ensure that 8 of 9 staff [S1 through Staff #8 (S8) had been trained on either Personal Protective Equipment (PPE) or the facility’s written LIC610 Emergency Disaster Plan within the last year, as required. Five (5) deficiencies were cited per California Code of Regulations, Title 22, and three (3) deficiencies were cited per California Health and Safety Code (refer to the LIC809-D pages). Plans of Correction were jointly developed with the Licensee. LPA also issued two (2) Technical Violations (TV), regarding frequency and variety of disaster drills and regarding knob protectors for the kitchen range (refer to the LIC9102-TV pages). An exit interview was conducted with House Manager Flavel Catahan, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TV pages, the LIC811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit. An electronic set of these same documents was E-mailed to the facility administrator.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with DSP Flavel Catahan. Today's visit was in response to Licensee’s self-reported death of Resident #1 (R1), received at the CCLD San Diego Regional Office on 02/19/2025. [See LIC 811 Confidential Names List for a description of R1]. Per the report, C1 passed away on 02/18/2025. During today’s visit, LPA performed a brief facility tour and welfare check on remaining three (3) residents, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff. No deficiencies were observed or cited during today’s visit. An exit interview was conducted with Catahan. A copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during the visit.the state’s words, verbatim · CDSS document, Mar 5, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Cristina Mascarinas. LPA also spoke with Administrator Lailani Velasco via phone during the visit. Today's visit was in response to licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 11/20/2024. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report]. Per the report, C1 passed away on 11/19/2024. During today’s visit, LPA performed a brief facility tour and welfare check on remaining clients, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff. Per review of CCLD’s Guardian Database and corroborated by staff and manager interviews: Staff #1 (S1), who was present at the facility during today’s visit, possessed an active background clearance from CCLD (to work in care facilities). However, Licensee did not ensure that S1 was associated to the facility’s roster of staff, as was required. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the LIC809-D page). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Administrator Lailani Velasco, to whom a copy of this report, the LIC809-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.the state’s words, verbatim · CDSS document, Nov 20, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80019(e)(3) · Plan of correction due date: Dec 20, 2024

80019 Criminal Record Clearance: “(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f)…” This requirement was not met, as evidenced by: Based on records and manager interview, Licensee did not ensure that 1 of 11 staff (S1), who was subject to a criminal record review pursuant to Health and Safety Code Section 1522, requested and received a transfer of criminal record clearance, prior to working at the facility. This posed a potential safety risk to 4 of 4 clients (C1 through Client #4) in care.the state’s words, verbatim · CDSS document, Nov 20, 2024

Plan of correction: CCLD records showed that S1 possessed a current Criminal Record Clearance. However, S1 was not yet associated to the facility roster. Licensee agreed to email to either use Guardian or the necessary forms to associate S1 to the facility's staff roster, by the POC due date. If updating in Guardian, Licensee will E-mail LPA upon completion of that process. If submitting forms to the CCLD regional office via E-mail, Licensee will Cc: LPA Nguyen.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with House Manager Flavel Catahan. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom six (6) may be non-ambulatory. The facility does not feature a secured perimeter and egress doors. LPA, accompanied by Flavel Catahan, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to clients were all compliant. There was at least 2 days supply of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to clients. Medications were labeled, as required, and stored in locked areas. (CONTINUED ON LIC809-C) (CONTINUED FROM LIC809) No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Confidential records were stored in locked areas. Flavel Catahan also presented proof of current/active business liability insurance. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Flavel Catahan, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Sep 20, 2024