Care 4 One II

Type of visit: Required - 1 Year

On 03/05/2026 at 11:30AM, Licensing Program Analyst (LPA) Andrew Christy arrived unannounced to conduct the 1-Year Annual Required inspection. LPA met with Administrator, Liza Elegado, and explained the purpose of the visit. The facility currently houses five (5) residents with a max capacity of six (6) residents. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. No bodies of water were observed. A comfortable indoor temperature is maintained at 70.0 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured at 105.3 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 06/26/2025. At 12:30PM, LPA reviewed five (5) resident files and five (5) staff files. The emergency disaster plan was last reviewed 03/05/2026. Quarterly emergency drills were last conducted 01/09/2026. A review of resident medications and the Medication Administration Record (MAR) found no outstanding errors. Continued on LIC809C..... Continued from LIC809..... The following deficiency was cited during inspection: At 12:30PM, during file review, it was found that all residents were missing updated Appraisal Needs And Service Plans (LIC625), signed Consent For Emergency Medical Treatment (LIC627C), signed Personal Rights (LIC613C), and signed Inventory Lists. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report, along with Appeal Rights, was provided to the Administrator.the state’s words, verbatim · CDSS document, Mar 5, 2026

Allegation investigated: Staff are not trained on emergency disaster protocols Staff are not providing activities for residents

On 10/08/2025 at 9:30AM, Licensing Program Analysts (LPAs) T. Syess-Gibson and Andrew Christy arrived unannounced to deliver complaint findings for the above allegations. LPAs met with Emma Baldeo, Caregiver and explained the reason for the visit. Emma contacted Administrator Liza Jay Elegado who arrived at 10:08AM. During the investigation, LPA reviewed and obtained documents, interviewed staff members, residents and witness. Continue on LIC9099C.. Substantiated Continued from LIC9099 Staff are not trained on emergency disaster protocols During investigation, LPA interviewed three (3) residents and two (2) staff members. Interviews with residents R1, R2 and R3, revealed that there haven’t been any emergency disaster drills (fire/earthquake) since admissions. Interviews with staff S1 and S2 revealed no emergency disaster drills have been conducted since 2023. Staff are not providing activities for residents During investigation, LPA interviewed three (3) residents and two (2) staff members. Interviews with residents R1, R2 and R3, revealed that the only activity they have participated in is with a Physical Therapist (PT) who visits one of the other residents twice a week. Interviews and record review revealed the facility isn’t providing residents with activities that develop their quality of life. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Oct 8, 2025 · control 15-AS-20250709144316

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1531.2(7) · Plan of correction due date: Oct 15, 2025

1531.2(7) Emergency fire and earthquake drills shall be conducted at least once every three months, or more frequently as required by a county or city fire department or local fire prevention district. The drills shall include all facility staff and volunteers providing client care and supervision. This requirement is not met as evidenced by: Based on interviews and file review, the licensee did not comply with the section cited above by not having emergency fire and earthquake drills at least once every three months for the residents in care which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 8, 2025

Plan of correction: Administrator agreed to read health and safety code1531.2(7), conduct training at least once every three months and email CCLD names of staff participants with signatures by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a) · Plan of correction due date: Oct 15, 2025

(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include: This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by not having planned activities that maintain and develop quality of life for the residents in care which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 8, 2025

Plan of correction: Administrator agreed to create a planned activity calendar with activities that will develop quality of life for residents in care and email photos of monthly activities to CCLD by POC date.

Type of visit: Required - 1 Year

On 3/14/25 at 10:15 AM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Liza Jay Elegado and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water in the kitchen sink was measured at 117 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors, fire extinguisher and carbon monoxide detectors were in operating condition during visit. First aid kit was observed to be complete. LPA reviewed 5 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 3/21/25: LIC 610E Emergency Disaster Plan No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 14, 2025

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 04/19/2024 at 1:40 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Administrator, Liza Jay Elgado and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 05/1/2023. At 2:02 pm LPA reviewed 5 residents records. At 2:45 pm, LPA reviewed 2 staff records and 2 of 2 were fingerprint cleared and associated to the facility. The following deficiency was observed during the visit: The resident files are not complete Break fluid found in yard Facility does not have oxygen in use sign up The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 19, 2024