A and M Board&Care, Innovative Assis.Home for Elder

Type of visit: Required - 1 Year

On 9/25/2025 at 10:45 am Licensing Program Analysts (LPA) K. Nguyen and P. Manalo arrived unannounced to conduct the 1-year annual requirement. LPA was greeted by care staff, Juan Pao Guintu and explained the purpose of the visit. LPAs spoke with Licensee Maria Linda Erolin and explained the purpose of the visit. Licensee arrived at 11:45 AM. LPAs with Licensee inspected the facility inside and out, including but not limited to resident rooms, bathrooms, living room, kitchen, dining area, and backyard. Hallways and passageways were observed free of obstruction. There was a sufficient supply of perishable and nonperishable foods. Towels, linen, and warm blankets were observed to be sufficient. Bathrooms and shower rooms have grab bars, a nonslip mat, and hygiene products. Smoke detectors and carbon monoxide were observed operational in the facility hallway. Hot water in the shared bathroom measured at 112.5°F. Fire extinguisher in the kitchen appears full and was last serviced on 07/07/2025. The first aid kit was observed to be complete. Emergency Drills was last conducted on 07/12/2025. LPA reviewed 3 resident files and 3 staff files. LPA reviewed the medication and log. Report continued to LIC809c... Continue from LIC809-C... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/02/2025: LIC 500 Personnel Report THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING THE VISIT: LPAs observed medication left on the table in the staff breakroom and in the residents' room. LPAs observed fruit flies in the dining area, on the countertop, and on the walls. LPAs observed expired food in the refrigerator and spoiled/molded fruits in the basket. LPAs conducted a file review. S2 does not have TB on record LPAs conducted a file review. S2 does not have CPR on record LPAs conducted residents' files; 3 out of 3 do not have an updated assessment on record LPAs observed foul odor coming in Room # 2, hoyer lift in the living room, two hoyer lift in the backyard, flies all around the facility, fridge and freezer not clean, etc. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. A $250 civil penalty is assessed for repeat violation within 12 12-month period of section 87555(b). Failure to submit proof of corrections by the plan of correction due date may result in additional civil penalties. Exit interview conducted. Appeal Rights, LIC421FC Civil penalty assessment, LIC9098 Proof of Correction form and copy of this report provided. Exit interview conducted. Appeal Rights and a copy of this report are provided.the state’s words, verbatim · CDSS document, Sep 25, 2025

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 10/8/2024 at 10:0AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a 1 year annual requirement visit. LPA met with Care staff and explained the purpose of the visit and later Licensee, Maria Linda Erolin later arrived. When entering the facility LPA observed an individual (visitor) in the kitchen prepping food for residents. LPA interview S1, S2, and S3 stated the individual stay at the facility helping. LPA confirmed that the individual, and reviewing Guardian system the individual is not background clear. Civil penalty of $100 is being assessed. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 8, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(3) · Plan of correction due date: Oct 8, 2024

Personnel Requirements - General. Request and be approved for a background, and criminal record exemption... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not having background, and criminal record which poses an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Oct 8, 2024

Plan of correction: Facility has agreed to obtain background and criminal record for any induvial that are assisting residents moving forward. Civil penalty of $100 is being assessed.

Type of visit: Required - 1 Year

On 10/8/2024 at 10:30 am Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-year annual requirement. LPA meet with was greeted by care staff, Teresita Dimain and explained the purpose of the visit. LPA spoke with Licensee Maria Linda Erolin and explained the purpose of the visit and arrived at 2pm. LPA with Licensee inspected the facility inside and out including but not limited to resident rooms, bathrooms, living room, kitchen, dining area and backyard. Hallways and passageways were observed free of obstruction. There was sufficient supply of perishable and non perishable foods. Towels, linen and warm blankets were observed sufficient. Bath/shower rooms have grab bars, non skid mat and hygiene products. Smoke detectors and carbon monoxide were observed operational. Fire extinguisher in the kitchen appears full and was last serviced on 1/29/24. First aid kit was observed complete. LPA reviewed 5 resident files and 6 staff files. LPA reviewed medication and log. Report continued on LIC809c... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: · LPA observed medication left in the Ziplock bag on the couch, and mediation in resident room 1 is on the counter. · LPA observed hot water temperature measured at 140.2-degree Fahrenheit. · LPA observed multiples cockroach in the kitchen cabinet, countertop, and in the garage food pantry. · LPA observed expired food in the refrigerator and molded fruits in the basket. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 8, 2024