Family Resort Rest Home

Type of visit: Required - 1 Year

On 1/27/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required visit. LPA was greeted by Administrator Nelly and explained to Nelly the purpose of the visit. LPA Flores conduced a tour of the facility alongside Administrator and was advised that the facility current does not retain any residents. During the visit, LPA observed the following: The facility is a single-story structure which consisted of (3) three resident bedrooms, (1) staff bedroom, (4) four bathrooms, living room, great room, formal dining room, kitchen, and garage. LPA observed an additional guest house which will not house any residents. All indoor and outdoor passageways were free from obstruction. The facility maintained a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. Emergency food and water supply is present. There is a location for sharps in the kitchen. Resident bedrooms were equipped with the required bedding, furniture, and functional lighting. Bathrooms were observed to maintain the required grab bars and slip resistant materials. Food prep areas are sanitary and organized. The carbon monoxide and smoke detectors were observed to be fully operable. Medication is anticipated to be centrally stored in a locked cabinet located in the kitchen. Per Administrator, there are no firearms and/or ammunition on the premises. LPA observed the required posting of the PUB475, LTCO, personal rights, and license. LPA was unable to review resident records due to there not being residents. LPA was unable to review staff records as there are no additional staff employed. LPA observed a locked file cabinet in the great room which will store potential resident files. Nelly Custodia Administrator Certification expires on 10/23/2026. During the visit, LPA did not observe any health and safety concerns. An exit interview was conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Jan 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that zero (0) residents live at this facility. There was one (1) staff member present. The Licensee/Administrator, Nelly M. Custodia was advised of the annual and conducted and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Zero (0) records were reviewed. LPA would have reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. One (1) record were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Nelly Custodia, Administrator’s certificate expiration date was 10/23/2024. Custodia stated that she submitted her renewal, to the Department on 09/30/2024. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the laundry room. There is a locked location for storing laundry soap, cleaning supplies and chemicals in the closet in the hallway. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There are two (2) secured fireplaces at this facility. There are zero (0) pools at the facility. There are one (1) secured gates that have a self-latching lock located on the northwest side of the house. LPA observed emergency supplies and two (2) first aid kit. The last emergency fire drill was conducted on 10/01/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed five (5) dual smoke detectors and one (1) carbon monoxide detectors throughout the facility. There were two (2) fire extinguishers on site purchased 10/01/2024. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Licensee/Administrator, Nelly M. Custodia.the state’s words, verbatim · CDSS document, Dec 2, 2024

Type of visit: Required - 1 Year

On January 16, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with the Administrator, Nelly Custodia. The facility file review was conducted in the office and additional records were requested and reviewed on site. The facility is licensed for six elderly adults and operating at a capacity of one. LPA Mixson toured the facility along with the Administrator and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home, located at 3014 El Ku Avenue. Escondido, CA 92025. Physical Plant: The facility phone number is (760) 489-0415 and is operable. The LPA observed the resident's bedroom, and it was equipped with required furniture as per Title 22, at the time of this visit. The LPA inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguisher. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files and it was locked. Medications: were reviewed, locked and inaccessible to residents, and there was a 30 day supply. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, one staff at the time of this visit and the staff was engaging the resident in activity and snack. Records Review: The LPA reviewed staff and resident files and conducted staff interviews, and resident interviews. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted and a copy of this report was given to the Administrator, Nelly Custodia.the state’s words, verbatim · CDSS document, Jan 16, 2024