A Faithful Home of Huntington Beach

Type of visit: Required - 1 Year

On July 24, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purposes of conducting a required 1-Year annual visit using the CARE Inspection Tool. LPA Bentley was greeted and granted entry into the facility by staff, after stating the reason for the visit. Administrator (AD) Theresa Kholoma was contacted by telephone and assisted with the visit. AD was unable to be present and designated Administrator Amelia Morales to sign the report. AD Morales has an Administrator certificate, which expires on October 22, 2027. The facility is licensed to operate age 60 and over for six (6) non-ambulatory residents, with a Hospice waiver for six (6). The building is a single story structure located in a residential neighborhood, which consists of the following: four (4) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, an outdoor covered seating area, and an attached two car garage. Currently, There are currently four (4) resident on census and present. LPA Bentley toured the inside and outside of the physical plant with staff. All rooms were inspected and the facility was observed to be appropriately furnished at the time of visit. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Additional linens, comforters, and bath towels were adequately stocked and available. Bathrooms were found to be clean and operational with water temperatures measured between 114.9 and 119 degrees F. The kitchen was observed clean and there was a two-day supply of perishable and seven-day supply of non-perishable food available. Toxins, disinfectants, sharps, and medications were secured. The backyard was observed with a shaded seating area for residents and the facility has two exit gates that were operational. LPA observed one out of five stove burners non-operation and the facility plans to repair/replace it. Evaluation Report Continues on LIC 809-C The smoke alarms and carbon monoxide detectors were operable. An emergency safety drill was last conducted on May 5, 2026 and are conducted quarterly. Emergency food, emergency water, and emergency supplies were observed. The facility has two (2) fire extinguishers that were charged, mounted, and last serviced on August 13, 2025. First aid kit is maintained and contains all the necessary elements. A working telephone (657-227-8120) remains available, however the facility does not have a device that can be used by residents for teleconference purposes. Liability Insurance is effective September 1, 2025 and expires on September 1, 2026. LPA Bentley conducted an audit of four (4) resident files (R1-R4), four (4) staff files (S1-S4), and medication and medication administration records review. Interviews were conducted with staff and residents. The record review revealed that two staff members do not have a completed Health Screening Report (LIC503). Although, the resident Needs and Service Plans were completed, four out of four were observed with missing signatures. Based on today’s observations, deficiencies are being cited as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrators, and a copy of this report, LIC809-D, LIC811s, Technical Violations, and appeal rights were provided at the end of the visit. NOTE: LPA called Administrator Theresa Kholoma and discussed the report and deficiencies.the state’s words, verbatim · CDSS document, Jul 24, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to the facility to conduct a Required Annual Inspection. LPA Haddadin was greeted by Staff (S1), Jomar Alejandro, who granted entry. The purpose of the visit was explained, and S1 accompanied the LPA throughout the inspection. The inspection included a comprehensive tour of the facility's interior and exterior, including common areas, resident rooms, the kitchen, the garage, and the backyard.The facility is a single-story house with four resident bedrooms, two bathrooms, a living room, a kitchen, a dining room, and a two-car garage. Smoke and carbon monoxide detectors in common areas and bedrooms were tested and found to be operational. The fire extinguisher, mounted in the kitchen, had a documented service date of August 14, 2024. The fire drill log indicated the last drill was conducted on May 25, 2025. The two side emergency exits were clear of any obstructions. In the kitchen, a two-day supply of perishable and a seven-day supply of non-perishable foods and water were observed. Kitchen appliances were operational, and sharps and knives were locked and inaccessible to clients. Clients’ bedrooms contained the required furniture, bed linens, and adequate closet and drawer space. Restrooms, toilets, and water faucets were operational. Grab bars were secure,and showers were free of mold and mildew. The water temperature was measured between 115.5 and 117.7∘F. The backyard was observed to have a shaded seating area for clients’ enjoyment. A review of three resident files was conducted. The review of Resident 1's (R1) file revealed that the date, time, and dosage for PRN (as-needed) medication administrations were not logged. Based on the observations made during today’s inspection, deficiencies are cited in accordance with the California Code of Regulations, Title 22, Division 6. An exit interview was conducted with Jomar Alejandro to discuss these findings. A copy of this report and information regarding appeal rights were provided to staff at the conclusion of the inspection. NOTE: LPA called licensee Ignacio Rudy and discussed the report and deficienciesthe state’s words, verbatim · CDSS document, Jul 17, 2025