Buckingham Residential Care Home

Type of visit: Required - 1 Year

At approximately 8:35 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a 1-Year Required Visit. Administrator, Angelica Martinez, arrived to facility at approximately 8:55 AM. The facility is a two (2) story house with staff rooms and one (1) bedroom for an ambulatory resident on the upper level. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) ambulatory resident for a total capacity of six (6) residents. Facility has an approved hospice waiver for two (2) residents. Upon arrival, LPA was informed that there were five (5) Residents in care. At approximately 9:00 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 9:05 AM, LPA toured the facility. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged on 10/7/2025. The facility was sufficiently lighted. LPA inspected four (4) 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. Per regulations the facility is required to conduct fire and emergency drills quarterly. The facility is not keeping a Disaster Drill log. This deficiency will be cited. 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 9:50 AM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were observed with all required documentation. LPA reviewed four (4) staff files. One (1) of four (4) staff files (for staff member S1) was observed to have an expired First Aid and CPR certification. This deficiency will be cited. Three (3) of four (4) staff files were observed with all required documentation including First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Angelica Martinez’s Administrator Certification 7000290740 is current with an expiration date of 4/10/2027. LPA requested the following documents be submitted to Community Care Licensing by 1/19/2026: 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, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Martinez. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Dec 19, 2025

Type of visit: Required - 1 Year

At approximately 9:00 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a 1-Year Required Visit. Administrator, Angelica Martinez, arrived to facility at approximately 9:20 AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) ambulatory resident for a total capacity of six (6) residents. Facility has an approved hospice waiver for two (2) individuals. Upon arrival, LPA was informed that there were five (5) Residents in care and three (3) staff members on-site. At approximately 9:30 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 with the exception of one (1) staff member (S3) who had background clearance but was not yet associated with the facility. Please see the attached 809-D regarding S3 not being associated to the facility. At approximately 10:00 AM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 2 story building with 6 Resident bedrooms, 3 resident bathrooms, one shower room, 2 staff rooms, 1 staff bathroom, and common spaces. LPA observed that two (2) of two (2) residents' bathrooms did not have waste receptacles with tight fitting covers. A Technical Violation (TV) was issued for the waste receptacles not being in compliance. Facility has an Infection Control plan on file. 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. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Continued on 809-C... ...Continued from 809 During walk through, LPA observed that facility currently does not have an evacuation chair on-site, but all residents currently live on the first floor. A Technical Violation (TV) was issued for the facility not having a evacuation chair on site. LPA advised Administrator to purchase an evacuation chair in the event they have a resident move into the room located on the second floor. LPA reviewed five (5) resident files. Five (5) of five (5) resident files were found to be well organized and thorough with all required documentation. LPA reviewed four (4) staff files. During staff file review, LPA observed that two (2) staff files did not have or have an incomplete LIC501/Personnel Reports. Please see the attached 809-D regarding missing staff files. Staff files had current First Aid and CPR certification and proper training documentation. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. Facility's fire extinguishers were found to be last inspected September 2024. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility conducts emergency drills quarterly with the last emergency drill conducted 1/15/2025. Administrator's Certificate for Angelica Martinez (70000290740) is current with an expiration date of 04/10/2025 LPA is requesting the following documents be submitted to Community Care Licensing (CCL) by DOB: 3/3/2025 Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Exit interview conducted. Copy of report, LIC809D (Deficiency Page) with plans of corrections, LIC9102s Technical Violations, Confidential Names (LIC811), and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 3, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

At approximately 3:40PM, Licensing Program Analyst (LPA) Felias, arrived unannounced to conduct a Case Management - Other Visit and met with Staff Member, Erwin Marayag. Licensee/Administrator, Angelica Martinez, arrived during visit at approximately 4:00PM. The purpose of the visit is to confirm an Order to Individual for Immediate Exclusion for All Facilities. The Department delivered an "immediate exclusion" notice on 04/29/2024 to facility. Per notice, Staff Member 1 (S1) cannot be allowed to work, be present and/or live in a CCL licensed facility, or have contact with residents in any residential facility or child day care licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with residents and not allow this employee to be physically present in the facility. Licensee/Administrator informed LPA that S1 had been removed from the facility and from the facility's staff roster. Licensee/Administrator stated they understood the notice. No Deficiencies Cited during visit. Exit interview conducted. Copy of report and LIC811 (Confidential Names) discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, May 7, 2024

Type of visit: Required - 1 Year

At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Jessica Lopez. Administrator, Angelica Martinez, arrived to facility at approximately 10:15AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for 5 non-ambulatory residents and 1 ambulatory resident for a total capacity of 6 residents. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 5 Residents in care and 2 staff members on-site. At approximately 9:40AM, 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 10:20AM, LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 2 story building with 6 Resident bedrooms, 3 resident bathrooms, one shower room, 2 staff rooms, 1 staff bathroom, and common spaces. Facility has an Infection Control plan on file. 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. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. During walkthrough, LPA observed that facility currently does not have an evacuation chair on-site, but all residents currently live on the first floor (See Technical Advisory, LIC9102, H&S Code, 1569.695(f)(1)). LPA advised Administrator to purchase an evacuation chair in the event they have a resident move into the room located on the second floor. LPA reviewed staff files, resident files and resident medications. All Files were all found to be well organized and thorough. During staff file review, LPA observed that 3 of 5 staff files did not have an LIC501/Personnel Report (See Technical Advisory, LIC9102, regulation 87412(a)(7)). Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Continued on LIC809C Continued from LIC809 Facility's fire extinguishers were found to be last inspected September 2023. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted December 2023. Administrator's Certificate for Angelica Martinez (6001706740) is current with an expiration date of 04/10/2025 LPA is requesting the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Active and Current Administrator's Certificate when available Facility Documents to be submitted to Community Care Licensing (CCL) by due date of Saturday, 03/23/2024. No Deficiencies Cited during visit. Exit interview conducted. Copy of report. LIC9102 (Technical Advisory/Violation) discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Feb 23, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.