Primetime Care

Type of visit: Required - 1 Year

At approximately 1:00 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Administrator Thelma Sy. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Facility has a fire clearance approval for all non-ambulatory residents. At approximately 1:20 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 7/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 110.4- and 115.5 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Activities include outings into the community, karaoke, and digital games. Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. A new facility phone number was acquired during this visit. Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 1/26. LPA reviewed emergency disaster plan which was last updated 10/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 2:20 PM LPA conducted a review of four (4) resident records. All required documentation present. At approximately 2:00 PM LPA conducted review of three (3) staff records. Administrator will audit staff records. At approximately 2:40 PM LPA and Administrator conducted check of P&I. All records present and cash is reconciled. At approximately 2:50 PM LPA and caregiver conducted a spot check of medication and medication records. Medication is centrally stored and locked. Thelma Sy Administrator Certificate 7006452740 expires 10/25/2026. Updated copies of the following documents were gathered during this visit: Liability Insurance LIC500 - Personnel Report LIC308 - Designation of Responsibility No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Feb 12, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:35 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Administrator Thelma Sy and Licensee Danilo Sy. Primtime Care, LLC is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for four (4) non-ambulatory Residents. Upon arrival, LPA was informed that there were four (4) residents in care. During the inspection all residents were away at day programs. At approximately 9:50 AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:00 AM, LPA toured the facility with Administrator Sy. All exits were clear and unobstructed. The facility's fire extinguisher was last serviced and tagged on 6/12/2024. The Vallejo Fire Department's last inspection was on 7/26/2024. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 1/22/2025. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 10:35 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were found to be well organized and thorough with all required documentation. LPA reviewed three (3) staff files. All staff files were found to be well organized with all required documentation including First Aid and CPR certification. One (1) staff member had incomplete training documentation. A Technical Advisory is being issued for the incomplete training documentation. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. Resident’s monies for personal and incidental (P&I) items were audited and found to exceed the values listed on the LIC 400 Affidavit Regarding Resident Cash Resources. This deficiency will be cited. Thelma Sy’s Administrator Certification 7006452740 is current with an expiration date of 10/25/2026. LPA requested the following documents be submitted to Community Care Licensing by 4/18/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, LIC 9102 Technical Advisory and Appeal Rights discussed and provided to Director Licensee Danilo Sy. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Mar 18, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Caregiver/Administrator Andres Villaluz. Licensee/Administrator Danilo Sy arrived during visit. This facility has a fire clearance for four non-ambulatory. There are three resident rooms: two private and one shared. The shared resident room has a private full bathroom. All three resident rooms have an exit to the outside. There is one full common bathroom. There is one staff room. The backyard has a covered area. The following was observed during today's visit: -facility meets the seven day non-perishable and two day perishable food supply. -two of three resident records were reviewed -all staff files were reviewed -the backyard has furniture and two appliances that Caregiver stated is going to be picked up soon. The furniture and appliances are stacked and placed in ways that do not impede any walkways in the back nor do they pose a hazard. LPA was informed the items are being picked up this Friday. The following shall be updated and submitted to Community Care Licensing Division by April 19, 2024: -a copy of the current liability insurance -LIC 308 designation of administrative responsibility -LIC 500 personnel report or staff schedule No deficiencies were observed. No deficiencies cited.the state’s words, verbatim · CDSS document, Mar 27, 2024