C&R Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection and was greeted by administrator (admin) Romulo Bautista. Facility is an Adult Residential Care Facility for the Elderly with an approved fire clearance for capacity of 6 (six) residents. There are currently four (4) residents in care with one resident on hospice. LPA toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were last inspected 8/26/2025. Fire alarm and carbon monoxide alarms all tested and operational. Outdoor furniture accessible for resident use. Water temperature check measured within regulation at faucets accessible to residents within the allowable range of 105 to 120 degrees F. Resident bathrooms observed to have bath mat and grab bar. Disaster drills are being conducted monthly. All bedrooms were equipped with required furnishing. Facility had an ample supply of linens, towels and extra hygiene products for residents. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Emergency food and water was observed to meet the 72 hour emergency supply Facility kitchen, refrigerators and freezers were clean. Expiration dates were not noted in any food items found in refrigerator and freezer. LPA had conversation with admin that food needs to be properly labeled with expiration dates noted (Technical Violation given). Toxins are locked and inaccessible to residents. Sharps and knives were locked. Phone accessible for resident use. LPA conducted a file review for 4 out of 4 residents. S1 and S2 did not have an updated medical assessment (MA). S1 last MA was completed in 2022 and S2 last MA was from 2023. (Deficiency Cited, See 809D). continued to 809C... continued from 809.... LPA conducted file review for 4 staff, training found to be up to date. LPA and admin conducted a spot check of medication. Medication is centrally stored and locked. Two medications not found noted in Centrally Stored Medication Log, LPA had conversation with admin that all medication must be noted in log carefully (Technical Violation given). Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance LIC610E Emergency and Disaster plan Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and report read with Administratorthe state’s words, verbatim · CDSS document, May 7, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a Post Licensing Inspection after Change of Ownership and was greeted by staff. Administrator Romulo Bautista arrived shortly after. Facility is an Adult Residential Facility for the Elderly that has an approved fire clearance for capacity of 6 ambulatory and non-ambulatory residents. There are currently 5 residents at facility. LPA and admin toured all buildings and grounds and were found to be clear from obstruction. Facility was found to be clean and at a comfortable temperature. All required postings were visible. There was a sufficient supply of perishable and nonperishable foods as required by Title 22 Regulations. Emrgency food observed. LPA observed no expiration dates noted on food items (Technical Violation given). All resident rooms were observed to be clean and have the proper linens. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperature for sinks found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Detergent found to be under bathroom sink. Admin removed and had conversation with admin that all chemicals need to be locked (Technical Violation given). Facility's fire extinguisher was observed to be charged and last inspected on 8/26/2025. Smoke and carbon monoxide detectors were tested and operational. Disaster drills are being conducted quarterly with last drill done on 11/10/2025 Continued to 809C..... continued from 809C... LPA conducted a file review check for 5 out of 5 residents. All documentation found to be in file. LPA discussed with admin having Admission Agreements under new license name (Advisory given). In addition, signature for Appraisal Needs and Service Plan was missing for 2 residents (Technical Violation given). LPA conducted staff resident review for 3 staff. All documentation up to date. LPA conducted medication spot check and found Centrally Stored Medication log up to date and medication locked and secure. Admin to send updated LIC500 within 30 days of visit for updated file. No deficiencies cited during todays visit. Exit interview conducted. Copy of report discussed and provided to Licensee.the state’s words, verbatim · CDSS document, Dec 4, 2025

Type of visit: Prelicensing

At approximately 10:00am Licensing Program Analyst (LPA) Contreras arrived for an unannounced pre-licensing visit and met with administrator (admin) Romulo Bautista. Current admin Robert Bayot was also present. This pre-licensing inspection is being conducted for a change of ownership (CHOW) for a Residential Care Facility for the Elderly (RFCE). Facility is a one story, four bedroom, two bath home with a fire clearance granted for capacity of 6 residents. Waiver granted for hospice care for 6 residents. 3 residents currently in care. LPA toured the facility with admin of the indoor and outdoor portions of the facility. Facility was found to be clean and at a comfortable temperature with emergency exits free from obstruction. Facility contained all required postings. 3 out of 3 bedrooms accessible for residents all had required chair, chest drawer and beds were made with appropriate linens. 4th and master bedroom is used for staff. LPA and admin toured outside in the backyard and found all exits clear from obstruction. LPA observed non-perishable foods available but advised admin that more food enough for 7 day supply should be available in pantry and refrigerator. LPA advised admin to make sure emergency food and water supply is available at all times. Food in refrigerator was missing expiration dates and admin was aware that expiration dates must be put in all foods. Cleaning products, sharp items, other toxins and chemicals are locked and inaccessible to residents. Extra linens and towels were available in closets. Water was measured at 110.8 degrees F in faucets used by clients which is within regulation between 105 & 120 degrees F. Restrooms has required bath mats and grab bars. LPA observed fire extinguisher charged and last inspected 8/01/2024. Fire alarm and carbon monoxide alarms were tested and operational. Signal alarms were operational in front door and garage. Signal alarm for backyard needs battery replacement. LPA also advised admin that it must be kept on at all times. Continued to 809-C... Continued from 809.. LPA observed food thickener and cough medication in kitchen cabinet not locked or secure. Admin immediately removed medication and locked with rest of medication. LPA reviewed resident and staff files and all required documentation was present. LPA discussed with admin training requirements per regulations. RCFE Component III was reviewed with applicant at facility. No Deficiencies or Advisories given during visit. Pre-Licensing completed. Facility is ready to be Licensed as a Residential Care Facility for the Elderly. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicants of Status. Copy of report discussed and provided to Applicants. Exit interview conducted.the state’s words, verbatim · CDSS document, Jun 17, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 4 Method: Telephone call with CAB COMP II Participants: Bautista, Romulo On 5/14/25, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, May 14, 2025