Our House

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds,which is level and fenced. There is a detached storage shed, which is used by administrator and locked. There are 3 shared client bedrooms, and 2 staff rooms--1 room has 1 bed for 2 persons and the other has 3 beds for one staff. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested at 118 degrees in clients' bathroom. Food supply and first-aid kit are inspected and complete. Client files are reviewed, including Centrally Stored Medications Records--provided by pharmacy--and records of cash resources for 2 clients. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records and training. RCFE administrators, Lionel Pagador (x 12/27) and Lionel Pagador Jr.(x 10/27) oversee facility operations. Proof of current liability insurance and Emergency Disaster Plan (LIC610D) are given to LPA today. The following information/forms are requested to be sent to CCLD BY 3/17/26: - Designation of Facility Responsibility (LIC308) - Personnel Report (LIC500) - Affidavit Regarding Client Cash Resources (LIC400) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following page..the state’s words, verbatim · CDSS document, Mar 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c)(1) · Plan of correction due date: Mar 17, 2026

PERSONNEL REQUIREMENTS GENERAL Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met, as all staff have expired first-aid training. Licensee failed to ensure that staff providing care maintain valid first-aid training, which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: Proof of current first aid training for ALL staff will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.696 · Plan of correction due date: Mar 17, 2026

HEALTH AND SAFETY CODE RCFEs shall provide training to direct care staff on postural supports, restricted conditions or health services, hospice care...training shall include...4 hours of training on the care, supervision, and special needs of those residents... Four hours of training thereafter of in-service training per year on the subject of serving those residents. This requirement is not met, as there is no proof of this annual training for staff #2, #4 and #5. Licensee failed to ensure that all direct care providers have this annual training, which poses a potential health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: Proof of postural supports, restricted health conditons and hospice care training for staff #2, #4 and #5 will be sent to CCLD BY DUE DATE

Type of visit: Case Management - Annual Continuation

LPA Jeung issued citations and Technical Advisory Note to complete annual inspection of 3/4/25. Deficiencies observed on 3/4/25 of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are cited on a following page.the state’s words, verbatim · CDSS document, Mar 5, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87412(d) · Plan of correction due date: Mar 6, 2025

PERSONNEL RECORDS The licensee shall maintain documentation that an administrator has met... recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met, as there is no evidence that administrator has met the RCFE administrator recertification requirements. Licensee failed to ensure that there is certified RCFE administrator overseeing facility operations, which poses an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Mar 5, 2025

Plan of correction: Proof that there is a certified RCFE administrator overseeing facility operations will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.695(c) · Plan of correction due date: Mar 6, 2025

HEALTH AND SAFETY CODE A facility shall conduct a drill at least quarterly for each shift... type of emergency covered in a drill shall vary... taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, type of emergency ... names of staff participating in the drill. This requirement was not met, as there is no record that facility has conducted emergency disaster drills.the state’s words, verbatim · CDSS document, Mar 5, 2025

Plan of correction: Plan for implementation and performance of quarterly disaster drills will be sent to CCLD BY DUE DATE. In addition, upon completion of emergency disaster drill, documentation to be submitted to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(b) · Plan of correction due date: Mar 19, 2025

HEALTH AND SAFETY CODE Each employee who received training and ...who continues to assist with the self-administration of medicines, shall also complete 8 hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met, as there is no evidence that staff have received 8 hours of annual medication training. Licensee failed to ensure that staff who manage clients' medications received annual medication training, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Mar 5, 2025

Plan of correction: staff will receive at least 8 hours of annual training on medications. Proof of corrction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.605 · Plan of correction due date: Mar 19, 2025

HEALTH AND SAFETY CODE ...after July 1, 2015, all RCFEs... shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.This requirement is not met, as there is no evidence that facility maintains liability insurance, as required. Licensee failed to maintain required liability insurance coverage, which poses a potential health, safety or personal rights risk to clients.the state’s words, verbatim · CDSS document, Mar 5, 2025

Plan of correction: Proof of required liability insurance coverage --including policy dates--will be sent to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds,which is level and fenced. There is a detached storage shed, which is used by administrator and locked. There are 3 shared client bedrooms, and 2 staff rooms--1 room has 1 bed for 2 persons and the other has 3 beds for one staff. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested at 114 degrees in clients' bathroom. Food supply and first-aid kit are inspected and complete. Client files are reviewed, including Centrally Stored Medications Records--provided by pharmacy--and records of cash resources for 3 clients. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. RCFE administrator, Lionel Pagador, does not have current administrator certification. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed. Citations and Advisory Notes will be issued at a later date due to technical difficulties.the state’s words, verbatim · CDSS document, Mar 4, 2025

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds, including, detached storage shed, which is locked. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Hot water temperature is tested at 115 degrees in clients' bathroom. Food supply and first-aid kit are inspected and complete. Client files are reviewed, and medications are recorded on Centrally Stored Medications Records, provided by pharmacy. An updated Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff records. Lionel Pagador is a certified RCFE administrator that oversees facility operations. The following form is requested to be updated and returned to CCL by 4/22/24: • LIC 500 Personnel Report Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Advisory Notes for technical violations to be corrected--3 pages.the state’s words, verbatim · CDSS document, Apr 8, 2024