Angels Assisted Living

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alviso conducted a case management, on 8/11/26 at approximately 9:30am, and met with Claudia Quijada, Licensee/Administrator. Lead staff Bertha "Berta" Calderon, was on-site with the Licensee during this inspection. This case management is being conducted in regards to the voluntary closure of this facility. Licensee notified the LPA that they will be closing the facility, and does not want to renew the license. LPA toured the facility and observed no residents in care. Licensee is moving out the rest of their belongings today, including all furnishings they chose to retain. Per licensee, all items, including furnishings not wanted by licensee were given away free to others, and any items left will be taken away and/or disposed of. Claudia Quijada stated their understanding that if wanting to operate a care home at this address, they would need to apply with a complete application to the Department; Any individual wanting to operate a care home at this address, would need to file an application with the Department as required, and be licensed prior to operating. Claudia Quijada relinquished original license to the LPA. The facility has closed effective 8/11/2026, this license, #496804200, is no longer valid as of today.the state’s words, verbatim · CDSS document, Aug 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 5/28/26 at approximately 9:45am, and met with Licensee/Administrator Claudia Quijada. Caregiver Gina was on duty; Administrator was contacted and arrived to the facility shortly after being notified of LPA's arrival. Lead staff Berta arrived and was on-site during the LPA's inspection. There are currently three (3) residents in care; There is no hospice care services being provided to any of the residents at this time. Facility has a fire clearance approval for a total of five (5) non-ambulatory, of which two (2) may be bedridden, resident rooms #1 and #2. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility is conducting required quarterly emergecy disaster drills. Last emergency disaster drill was conducted on 2/27/26, an earthquake drill. LPA reviewed three (3) resident files, including medication records. LPA reviewed four (3) staff files. All staff had required criminal record clearance. All staff had first aid certification and CPR certification. LPA reviewed staff training. LPA toured the facility with the Administrator. Hot water was measured at 114.6 degrees Fahrenheit. All exits were free and clear of obstruction. All common areas, bathrooms, hallways, and resident rooms had sufficient lighting. Food supply was sufficient. Sufficient linens, hygiene supplies, paper products, cleaners/disinfectants/soaps, and sufficient personal protective equipment (PPE) supplies. Grab bars and non-slip mats/textured shower flooring. Facility was clean and orderly. All medications were stored appropriately and locked up making them inaccessible to residents as required. Cleaners/disinfectants were locked up and and inaccessible to residents as required. Mo deficiencies cited during today's inspection. Exit interview was conducted with the Administrator Claudia Quijada.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 4/10/25 at approximately 10:00am, and met with Licensee/Administrator Claudia Quijada. There are currently two (2) residents in care and both are on hospice services. Lead staff/caregiver Berta, and Caregiver Yolanda were on duty during the inspection.. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has a fire clearance approval for a total of five (5) non-ambulatory, of which two (2) may be bedridden, resident rooms #1 and #2. All locks on exterior gates are approved. The self latching fire exit gate is never to have a lock on it. The facility does have emergency food, water, and miscellaneous supplies to meet the "72 hour shelter in place" requirements. Required fire drills/emergency drills are being conducted as required; Last drill, Earthquake, was conducted on 2/28/2025. LPA reviewed two (2) resident files; Resident files were complete. LPA reviewed two (2) staff files. LPA reviewed staff training. All staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. The LPA toured the facility with staff Berta Calderon. Hot water was measured at 112.8 degrees Fahrenheit. Continued on LIC809C... LPA observed that the facility was at a comfortable temperature. Food supply was sufficient. Facility had grab bars and a non-slip mat in shower stall for resident use. Sufficient lighting in all resident rooms, bathrooms, hallways, and common areas. Sufficient supply of cleaners/disinfectants, linens, furnishings, paper products, hygiene items, and personal protective equipment (PPE). All medications were centrally stored, locked up, and inaccessible to residents in care. Cleaners/disinfectants are locked up and inaccessible to residents in care. LPA is requesting the following documents to be updated and submitted by 5/10/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E (9 pages)-Emergency Disaster Plan -review and update as needed/required, submit copy Infection Control Plan- review and update as needed/required, submit copy Copy of LIC400 Handling of Client Cash Resources-all facilities complete this form Copy of Required Surety Bond- if handling cash Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate There are no deficiencies cited today. Exit interview conducted with Administrator/Licensee Claudia Quijada.the state’s words, verbatim · CDSS document, Apr 10, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Alviso conducted a case management inspection, and met with Administrator Claudia Quijada. The case management is being conducted to review a report of a resident AWOL. The LPA reviewed the incident with the Administrator, Administrator stated the resident R1 had left the facility out the front door without staff supervision. The staff on duty didn't hear the auditory alarm on the front door, and was unaware that R1 had left the facility. A Sheriff came to the facility regarding the resident R1 which a neighbor had called due to observing the resident wandering past their home. R1 was returned to the facility after the staff identified R1 as a resident of the care home. R1 was seen by paramedics that were called when the neighbor reported the resident was wandering in the neighborhood; R1 was assessed to have no injuries from the AWOL incident. LPA obtained more information on resident incidents and death reports, including the AWOL reviewed above that were not reported to Licensing as required, per interview with the Administrator. In review of the incident, The staff failed to hear the auditory alarm on the exit door and the resident (R1) AWOL the facility without staff supervision. This deficiency will be cited, 87705(d) Care of Persons with Dementia -The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, see LIC809D. Continued on LIC809C... Deficiency cited, 87211(a)(1)(2) Reporting Requirements-Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D). This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given to the Administrator/Licensee. Exit interview conducted with Administrator/Licensee Claudia Quijada.the state’s words, verbatim · CDSS document, Jan 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(d) · Plan of correction due date: Jan 31, 2025

87705(d) Care of Persons with Dementia -The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, This requirement was not met as evidenced by: Per LPA interiews LPA obtained more information on resident incidents and death reports, including the AWOL of R1 who left the facility without staffs knowledge. R1 was returned to the facility by the Sherriff who was called by a reporting neighbor. This is a risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Jan 15, 2025

Plan of correction: Licensee to ensure all exit door auditory alarms are working properly to ensure residents don't elope the facility without staff's knowledge and/or supervision. Hold an in-service training with all staff on dementia care plan regarding wandering, elopenment, and auditory alarms. Submit proof of training witth the staff. Submit plan of correction and proof of training by 1/31/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(2) · Plan of correction due date: Jan 31, 2025

87211(a)(1)(2) Reporting Requirements-Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D). This requirement was not met as evidenced by: Based on interviews, review of incident/death reports, including an AWOL it was found that they were not reported as required. There have been resident reports that licensing should have been notified of. This is a risk to potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 15, 2025

Plan of correction: Licensee to ensure that all reports, incidents and deaths, that need to be submitted to licensing are completed as required and submitted within regulation time frame. Submit all reports, incidents/deaths as discussed during the inspection that were not received by Licensing Department. POC due 1/31/25.

Allegation investigated: Staff did not ensure that resident had clean clothes Staff are not meeting resident's toileting needs

Licensing Program Analyst (LPA), Hansen arrived unannounced, for the purpose of delivering findings of complaint investigation, regarding the above listed allegations. LPA was greeted by staff Sandra who called Administrator who arrived shortley after. LPA met with Administrator Claudia Quijada. Staff did not ensure that resident had clean clothes- Complainant alleges resident (R1) is always wearing the same clothing and is not being showered. LPA conducted visits of facility on 6/7/2024 & 6/11/2024 and observed R1 to be dressed, clean shaven, without any odor, as well room was clean with many clean shirts hanging in the closet and clothes in dresser. LPA’s interview with R1 advised they do not need help showering or changing cloths. R1’s Physician’s report obtained dated 10/3/2022 revealed R1 is ambulatory and able to bathe self (with encouragement) and dress self. Interview with Administrator indicated R1 likes the same clothes and has many of the same style of clothing. R1 is private/shy and bathes reluctantly 1 to 2 times a week with assistance by caregiver who will be in the shower but without facing R1 directly. Continue on LIC9099-C Unsubstantiated Continue from LIC9099 Although R1 likes to wear the same type of clothing and is reluctant to shower, LPA’s record review, observations, & interviews conducted, allegation Staff did not ensure that resident had clean clothe is found to be Unsubstantiated. Staff are not meeting resident's toileting needs- Complainant alleges R2 is left with feces on private parts due to day staff not cleaning R2 properly. LPA contacted outside medical vendor who informed for the past three years of caring for R2 every other week, they have not observed R2 have feces on them or dirtied undergarments from incontinent issues. LPA spoke with an additional outside medical vendor who has seen R2 twice a week for the last two years and corroborated first medical vendors’ statement. LPA conducted visits of facility, reviewed records, and conducted interviews that did not indicate allegation Staff are not meeting resident’s toileting needs, therefore the allegation is Unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continue from LIC9099-A In the med closet were pre poured medications for all residents (see pics) including previous residents who left prior to CHOW. In the medication closet is a refrigerator for medications needing refrigeration. LPA observed it to be full of insulin for I1 (see pics). LPA will address on case management. Based on LPAs interviews with staff, complainant, and documents obtained indicating individual was not a resident under this license name or number, therefore allegation Resident did not receive medications as prescribed is Unfounded. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.the state’s words, verbatim · CDSS document, Aug 20, 2024 · control 21-AS-20240606100350

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hansen was at facility delivering findings of a complaint investigation and conducted a case management due to additional issues found during investigation. LPA met with Claudia Quijada, Administrator. During complaint 21-AS-20240606100350 investigation, an allegation resident did not receive medications as prescribed was investigated and although the individual was not a resident of this licensed facility, when LPA entered facility on 6/7/2024 LPA observed medication closet unlocked with all residents’ medications accessible and pre-poured for each resident including previous individual for at least a full day (see pics). LPA is citing facility for (87465(h)(2) leaving centrally stored medications accessible to persons other than employees and for 87465(h)(5) each resident's medication not being stored in its originally received container. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Aug 20, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Aug 21, 2024

87465(h)(2) Incidental Medical and Dental Care: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not met as evidenced by: Based on LPAs observation medication closet, housing centrally stored medications was left unlocked, with refrigerated insulin medications included. This is an immediate health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2024

Plan of correction: Admin to conduct staff training to ensure that staff know how to properly store centrally stored medication per regulation 87465(h)(2). Admin to submit date of training to LPA by POC due date of 8/21/2024 &. Administrator to submit documentation of staff training on regulation 87465(h)(2) with date, time, subject, duration, staff names and signatures of attendance. POC due date 8/27/2024 to CCL to clear the citation..

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Sep 3, 2024

87465(h)(5) Incidental Medical and Dental Care-The following requirements shall apply to medications which are centrally stored: Each resident's medication shall be stored in its originally received container. This requirement was not met as evidenced by: LPA observed that resident medications were pre-poured into daily medi-set cases for multiple full days, this is violation to regulation. This is a risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2024

Plan of correction: Administrator to ensure medications are not pre-poured in advance and ensure all staff handling medications and assisting residents with their medication are trained as required by Health and Safety Code 1569.69. Submit plan of ensuring medications are provided to residents by qualified trained staff and submit copy of LIC500 staffing schedule and list of staff that will be handling medications on each shift. POC due 9/3/2024.

Allegation investigated: Uncleared adult residing in facility

Licensing Program Analyst (LPA), Hansen arrived unannounced, for the purpose of delivering findings of complaint investigation, regarding the above listed allegation. LPA met with Administrator Claudia Quijada. Uncleared adult residing in facility- Complainant alleges there are individuals renting a room in the facility that is not cleared. Investigation revealed, the Administrator rented a room to an individual but had not associated them to this facility. LPA interview with Administrator, Individual (I1) has been renting a staff room in the facility but did not associate I1 to facility. On 6/7/2024 when LPA conducted 10 day and opened complaint, LPA was met by only staff (S1) at facility. When Administrator arrived and provided list of all facility staff, it was revealed not only was S1 but also S2 had been working at the facility between (2) two and (4) four months without being background checked /cleared to work, reside, or volunteer at a facility. Continue on LIC9099-C Substantiated Allegation, Uncleared adult residing in facility, is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. A $500.00 civil penalty was assessed on today’s date for not having a clearance transfer for I1. A $1,000.00 civil penalty was assessed on today’s date for uncleared adult S1 & S2. Total civil penalties today $1,500.00 The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Jun 11, 2024 · control 21-AS-20240606100350

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jun 12, 2024

Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement has not been met as evidenced by: Based upon statements and record review, I1 who is not associated to the facility and has been residing at facility for over 2 months. This poses an immediate risk to the safety and personal rights of the residents in care.the state’s words, verbatim · CDSS document, Jun 11, 2024

Plan of correction: Administration was given by end of 6/7/2024 to associate I1 to the facility as required by Title 22 regulations for CP’s to be $100, if not they would be $500. I1 was associated 6/10/2024. POC has been cleared at visit. ***Civil Penalties assessed at $500.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jun 12, 2024

87355(e)(1)Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health & Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met, As evidenced by: Based on interview with administrator, & S1, along with records reviewed it was revealed staff S1 & S2 did not have the proper fingerprint clearance & had access to residents in care for over 2 months. This is an immediate risk to the Health & safety of residents in care.the state’s words, verbatim · CDSS document, Jun 11, 2024

Plan of correction: Facility to submit a written plan that they understand regulation and how it will maintain compliance. Interview with Administrator and Background clearance/association revealed S1 is still in process and will not be in the facility until cleared and associated. S2 has been cleared and associated to facility. *** Civil Penalties assessed at $1,000.00

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Alviso conducted a pre-licensing inspection, at approximately 10:00am on 5/14/24, and met with Applicant Claudia Quijada; Claudia has a residential care for the elderly administrator certificate, #6060386740, expires 8/24/25. This application is a change of ownership, the facility is currently licensed as Green Meadows Living #2 - #496803534; Claudia Quijada is the facility's Administrator. Facility has a fire clearance approval by the Sonoma County Fire Department for a total of five (5) capacity, five (5) non-ambulatory, of which two (2) may be bedridden-effective 1/24/2024. Bedridden rooms are #1 and #2 only. All egress and perimeter locks approved, the backyards non-fire exit gate may be locked at all times. Applicant has applied for approval of a dementia plan of operation. Applicant has also applied for an approval of a hospice waiver for two (2). Applicant has submitted a required infection control plan, and a required emergency disaster plan as part of their application packet. Facility will operate with an awake night staff, and Licensee will ensure sufficient 24/7 staffing at all times. Hot water was checked at 116.4 degrees Fahrenheit, which is within regulation. All exits were unobstructed in the home. All exit doors had auditory alarms and the alarms were working properly during the inspection. Fire extinguishers, two (2), is serviced and tagged as required- expires 8/9/24. There are eight (8) smoke alarms that also can detect carbon monoxide, all were working appropriately. Facility has a sufficient supply of food, perishable and non-perishable There is a closet used for storage of resident medications, and is kept locked at all times, has a key-code entry pad.The garage has an auditory alarm to alert staff if any residents are trying to use that door. Continued on LIC809C... LPA observed sufficient supply of cleaners, paper products, hygiene products, and personal protective equipment (PPE). Applicant stated that the garage entry door from inside the house, has an auditory alarm, is monitored to ensure residents don't have access to items stored in the garage. The backyard has patio deck furnishings for resident use; There is a ramp off the backyard patio deck accessible from the dining rooms slider door, and from resident room two (2).There is a ramp in the front of the home leading to the front door of the facility. The facility does have emergency food items and other emergency supplies, to meet the "72 hour shelter in place" requirements. There was sufficient lighting throughout the facility in resident rooms, common areas, bathrooms, and hallways. The grounds were free of any apparent hazards, and exits were clear during the inspection. No bodies of water. No firearms. All bathrooms had grab bars for resident use, and mats/non-skid flooring for resident use. There is a sign in and sign out log at the front door. All postings required were posted, and visible upon entry into the facility. LPA reviewed three (3) resident files. LPA reviewed three (3) staff files. LPA conducted a component III orientation with Applicant Claudia Quijada, on 5/14/2024. Pre-Licensing has been completed today, 5/14/24, and the facility has no apparent hazards to health and safety observed by the inspecting LPA. LPA will forward a copy of the completed inspection to the Application Analyst. Application Analyst will notify the applicant of the status of the application.the state’s words, verbatim · CDSS document, May 14, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Change of Ownership Capacity: 5 Census (if any clients in care): 4 COMP II Participants: Claudia Quijada Interview Method: Telephone interview On April 18, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. 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. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 18, 2024