A Friendly Elderly Carehome

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, noel wolf petersen arrived unanounced to the facility to conduct the annual inspection. the LPA met with the administrator sharon drequito. The facility is licensed to have 6 residents, 4 of which may be nonambulatory, 1 of which may be temporarily added as a bedridded pending an inspection by the fire department. the inspection is completed 12/23/26, bedridden concerns were given passing results. The facility has one client(r4) who is bedridden on her 602; The LPA observed a second client (r1) was unable to rotate in bed on his own, despite the presence of assertive devices: half rails and an over the head hanger bar, meeting the departments definition of being bedridden and putting the facility in a state of operating outside its fire clearance. r1 does not have a bedridden status identified in thier 602, they do have a rail order and identified need for assistance rotation for wound care. There is no restricted care exception application for r1 at the time of the inspection. LPA was shown a reinspection clearing the dependancies for 1 bedrriden. A physical inspection of the facility, was conducted. no concerns physically other than the fire clearance. Fire extinguishers are dated 8/27/26. first aid kit has all required items. water temperature was measured between 105 and 120 *F. LPA reviewed 3 client files including 602's, health screenings, needs and services plan, applicable hospice care plans, and admission agreements. R1 has wound care needs, r2 has oxygen administration needs, r3 has dementia care needs and 602 out of dated from 3/14/26. LPA gave guidance that restricted care exceptions are necessary for wound care and oxgen care, they should be returned to the LPA before end of day 9/4/26. otherwise client files are present and up to date. LPA reviewed 3 staff files, training files for restricted care conditions are absent. otherwise staff files are present and up to date. LPA observed the 610d, 308, 402. 309 review pending to be submitted to the department. administrator files are otherwise up to date. continued on c page. The LPA is recommending the administrator send an email to technical support program requesting consulting assistance on a few topics for t22 regulations, TSP is recommended for admission agreements, staff training, and house rules. 1 citation issued, appeal rights provided. a copy of the report was read and given to the administrator. exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Aug 28, 2026

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal... This requirement was not followed as evidenced by: LPA observed 2 bedridden clients, 1 identified by record review of the 602(r4) and one meeting the departments definition by the LPA's observation of client r1 being unable to rotate in bed. the current license fire clearance is 6, 4 of which may be nonambulatory, 1 may be bedrriden. not following this requirement poses a risk to the health, safety, and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 27, 2026

Plan of correction: The LPA suggest that because they observed a bedridden capable room(w/ exterior door) with 1 client, the easiest plan of the administrator/licensee should be to update the fire clearance of that room to 2 bedridden. The facilities representative agrees, and the facilities next steps and supporting documents if applicaple should be sent to the LPA (noel.wolfpetersen@dss.ca.gov) before end of day 8/28. if the plan changes the LPA should be informed.

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 08/27/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff persons, Samuel Saahene and Mirasol Kasai, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator, Sharon Drequito, to inform her that CCL was present at this time for an annual visit. Current census was 5 residents. The facility designated Administrator was unable to be present at this time. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (2) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (2) residents diagnosed with dementia at this time. It was learned that there were (2) residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Laundry room, located prior to the garage door entrance, was toured at this time. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, # 6069174740, for Sharon Drequito was observed to have an expiration date of 04/07/2026 and in compliance at this time. Forms and documents were being updated in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility hallway cabinets, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the kitchen area, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher located in the kitchen area was observed to have been annually purchased from the local retail store, Costco Wholesale, on 06/19/2025 and found to be in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (3) facility personnel records was conducted and noted on the following LIC 859. A review of (5) facility resident records was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 27, 2025

Type of visit: Office

An announced office meeting was held with the facility designated Administrator, Sharon Drequito, on 04/01/2025 via Microsoft Teams with the following persons in attendance as well: Liza King, Licensing Program Manager (LPM) Charlie Yang, Licensing Program Analyst (LPA) Kathryn Thomas, Health Services Administration The purpose of this office meeting was to go over the participation of this facility with the Technical Support Program and review the findings and results of this engagement. These were the main areas of review for this facility, and it's representative, at this time: Personnel/Training Record Keeping Medication Management A discussion was held with the facility designated Administrator, Sharon Drequito, in regards to the above concerns and review. Training resources and guides were provided to the facility designated Administrator by LPM King at this time. Additional recommendations were also given the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's office meeting. Exit Interview A copy of this report will be scanned and sent, via email, to the facility designated Administrator as well.the state’s words, verbatim · CDSS document, Apr 1, 2025

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 01/15/2025 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff person Samuel Saahene and Mirasol Kasai. A brief interview was conducted with the facility staff persons at this time. This LPA requested that the facility staff persons go ahead and contact the facility designated Administrator, Sharon Drequito, to inform her that CCL was present at this time. Current census was 2 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior post licensing visit conducted on 11/16/2024. This visit was to follow up on the Plans of Correction that were due. The following deficiencies were observed and cited on 11/26/2024: All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Each resident's record shall contain at least the following information: (10) Reports of the medical assessment specified in Section 87458 Medical Assessment, and of any special problems or precautions. The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or non ambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether non ambulatory status is based upon the resident's physical condition, mental condition or both. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: Each resident's record shall contain at least the following information: (17) Documents and information required by the following: (A) Section 87457, Pre-Admission Appraisal; This facility did complete the Plans of Correction and provided all of the required forms and documents at this time. Plan of Correction clearance letters were printed and copies were provided to the facility staff person at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: Post Licensing

Unannounced Post Licensing visit made out to this facility on 11/26/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregivers, Samuel Saahene and Myrna Sibayan, who were briefly interviewed at this time. This LPA requested that they go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. Anabelen Vallarta arrived later to this facility while this LPA was conducting this post licensing visit. Current census was 2 residents. It was learned that this facility currently has (2) residents under the care of hospice at this time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located near the facility employee hallway office, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Additional food storage units were observed to be present and functional at this time. Laundry area, located near the garage area, was toured. Bleach, detergent, and all other cleaning supplies were reviewed to make sure that they were locked and made inaccessible to the residents at this time. Administrator certificate for Sharon Drequito was observed to have been completed with number 6069174740 that was set to expire on 04/07/2026 and in compliance at this time. Medication cabinet, located in the facility employee office area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located hanging on the kitchen wall, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located hanging on the kitchen wall, was observed to have been recently purchased from the local Costco store on 04/06/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 26, 2024

Type of visit: Prelicensing

Announced Prelicensing visit made out to this facility on 07/22/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility Applicants, Sharon Drequito and Anabelen Vallarta, who were briefly interviewed at this time. This LPA also later met other facility staff persons while conducting these interviews. Current census was 0 residents. It was learned that this facility will be seeking to accept and retain up to (2) residents under the care of hospice at any given time. It was learned that this facility will have a program to be able to accept and retain dementia residents at any given time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located near the facility employee hallway office, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Additional food storage units were observed to be present and functional at this time. Laundry area, located near the garage area, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate for one of the applicants, Sharon Drequito, was observed to have been completed with number 6069174740 that was set to expire on 04/07/2026 and in compliance at this time. Medication cabinet, located in the facility employee office area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located hanging on the kitchen wall, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located hanging on the kitchen wall, was observed to have been recently purchased from the local Costco store on 04/06/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 Component III was conducted with the facility Applicant, Sharon Drequito, at this time. This facility was found to be in compliance at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 22, 2024