Angel's Love RCFE 2

Type of visit: Required - 1 Year

On 01/06/23 at 10AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an infection control inspection. LPA met with administrator and explained the purpose of the visit. LPA observed 2 staff wearing face mask and 3 residents watching TV while the other 2 residents were resting in their bedrooms. LPA toured the facility including but not limited to the front entrance, screening station, hand washing stations, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs maintained at a central location and easily accessible for staff. Comfortable temperature is maintained at 74 deg F. Facility has a mitigation plan in place and maintains records of routine screening for residents and staff. The infection control leader is the administrator. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 01/07/23: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan including infection control plans · Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 6, 2023

Type of visit: Prelicensing

On 12/16/2021 at 11:30AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a Change of Ownership Pre-licensing Required inspection. LPA met with Applicant/Administrator and explained the purpose of the visit. The facility currently has 3 residents. Facility has an approved fire clearance dated 12/09/2021 for 6 residents. There are 5 bedrooms and 2 bathrooms. Posters including but not limited to Covid-19 related posters, complaint poster, Personal Rights were observed. All bedrooms were observed furnished with a bed, dresser, closet, nightstand, lamp and chair. Hallways and passageways were free of obstruction. There was sufficient lighting and furniture. The kitchen was observed clean and organized. There was sufficient supply of non-perishable foods observed. Plates, silver wares and glass wares were observed available. A copy of menu was posted on the refrigerator. Hot water measured at 119 F. There was a locked cabinet for medicine and resident files. Knives and other sharp objects and chemicals were kept in a locked drawer and cabinets in the kitchen & garage. There was sufficient supply of towels, sheets, blankets and hygiene products observed. Smoke detector and carbon monoxide were tested and observed operational. First aid kit was complete. There were activity materials available. Facility has a washer and dryer installed in the laundry room. There were no bodies of water observed. LPA observed that facility is ready to be licensed. No deficiencies were observed during visit. This report will be submitted to the Central Applications Branch (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Exit interview conducted and a copy of this report was provided to Applicant via email.the state’s words, verbatim · CDSS document, Jan 5, 2022

Type of visit: Case Management - Other

During the pre-licensing inspection on 01/05/22, Licensing Program Analyst (LPA) Daisy Panlilio conducted a Component lll presentation with applicant. During the Component lll presentation, LPA provided applicant information on how to operate the facility within Title 22 regulatory compliance as well as how to avoid common problem areas. Applicant confirmed understanding of regulations discussed. Exit interview conducted and a copy of this report was provided to applicant via email.the state’s words, verbatim · CDSS document, Jan 5, 2022

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type:CHOW-change in ownership Capacity: 6 Census (if any clients in care): 4 COMP II Participants: Marcelina Badeo Interview Method: Telephone interview On January 3, 2022 at 9:00 AM, Administrator participated in COMP II. Identification of the Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Administrator confirmed the understanding of the California Code Title 22 Regulations. 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 readiness Exit interview with Administrator, copy sent via email and informed Administrator to return a signed LIC 809 with copy of photo ID have been obtained.the state’s words, verbatim · CDSS document, Jan 3, 2022

Type of visit: Office

Component II completion: Unsuccessful Facility Type: RCFE Application Type:Change of Ownership (CHOW) Capacity: 6 Census (if any clients in care): 4 (3 non-ambulatory, and 1 bedridden) COMP II Participants: Marcelina Badeo, Administrator Interview Method: Telephone interview On December 17, 2021 at 10:00 AM, Administrator participated in COMP II. Identification of the Administrator was verified through interview questions based on photo ID and other identifying personal information. Administrator did not provide sufficient knowledge the program and the California Code Title 22 Regulations. Component II will be rescheduled. Exit interview conducted with Administrator and LIC 809 sent to Administrator via email. Administrator informed to return sign LIC 809 to CCLD before next COMP II.the state’s words, verbatim · CDSS document, Dec 17, 2021

Type of visit: Office

Component II completion: Unsuccessful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 4 COMP II Participants: Marcelina Badeo Interview Method: Telephone interview On December 17, 2021 at 10:00 AM, 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. Administrator did not provide sufficient knowledge the program and the California Code Title 22 Regulations. Component II will be rescheduled. Exit interview conducted with Administrator. Analyst sent copy of report via email to Administrator to sign and return LIC 809. Photo ID was verified via interview with copy of ID provided prior to call.the state’s words, verbatim · CDSS document, Dec 17, 2021