A Mother's Agape Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required annual inspection and was greeted by caregiver Neil Ferrer. Administrator (admin) Victoria Gonzalez arrived shortly after. Facility is an Adult Residential Care Facility for the Elderly with an approved fire clearance for capacity of 6 (six) residents. There are currently (5) five residents in care. LPA toured the building and grounds which was found to be clean and at a comfortable temperature. LPA observed all walkways and exits to be unobstructed. All required postings were in a highly visible area. Fire extinguishers were charged and last inspected 4/14/2025. Fire alarm and carbon monoxide alarms all tested and operational. Outdoor furniture accessible for resident use. Water temperature check measured within regulation at faucets accessible to residents within the allowable range of 105 to 120 degrees F. Resident bathrooms observed to have bath mat and grab bar. Disaster drills are being conducted quarterly. All bedrooms were equipped with required furnishing. Facility had an ample supply of linens, towels and extra hygiene products for residents. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable foods. Snacks accessible for residents. Emergency food was observed to meet the 72 hour emergency supply. Facility kitchen, refrigerators and freezers were clean, and food stored properly. Expiration dates were not noted in food items found in refrigerator(Technical Violation given). Toxins are locked and inaccessible to residents. Sharps and knives were locked. Phone accessible for resident use. Thick it Thickener found on shelf accessible to residents not centrally stored. LPA advised staff to ensure it is kept locked at all times. Continued onto 809C.. continued from 809.... LPA conducted a file review for 5 of 5 residents. All required documentation found to be up to date. LPA conducted file review for 4 staff. All required documentation found to be up to date. LPA and staff conducted a spot check of medication and medication records, all records up to date. Medication is centrally stored and locked. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance No deficiencies cited for today's visit. Exit interview conducted and report read with Administratorthe state’s words, verbatim · CDSS document, Apr 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct a required Annual inspection and was greeted by Administrator (admin) Victoria Gonzalez. Facility contact information was reviewed. At approximately 10:30 LPA toured the building and grounds with staff. The facility was found to be clean and at a comfortable temperature. Emergency exits clear from obstruction. Backyard accessible to residents with patio furniture. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and expiration dates labeled. Cleaning supplies were locked inside garage not accessible to residents. Pantry containing sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Restrooms accessible to residents had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 109.4 and 110 degrees F which is within the allowable range of 105 to 120 degrees F. One water heater for facility. Fire extinguishers were last inspected 4/14/2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted with each staff member during their respective training days, LPA observed all training dates for respective staff were within the quarter. Continued on 809C... Continued from 809... LPA conducted a review of 4 resident records. All required documentation present. Hospital bed and half rails orders on file for respective residents. LPA conducted review of 4 staff records. All required documentation present. At approximately 12:15pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. No deficiencies Victoria Gonzales Administrator Certificate #701417940 expires 3/01/2026. All fees are current as of this time. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Current Lease Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, May 29, 2025

Type of visit: Required - 1 Year

At approximately 8:30AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA rang the doorbell and knocked at the door with no answer. LPA attempted to contact Administrator, Victoria Gonzales. Staff responded and spoke through RING intercom and advised LPA they are assisting resident and will be able answer the door shortly. Staff answered door and LPA gained entrance to facility at approximately 9:00 AM. LPA was greeted by Niel Ferrer. Upon entry into the facility, LPA had temperature checked and logged. Administrator, Victoria Gonzales arrived shortly after at approximately 9:40 AM. The facility is a single story home licensed for six non-ambulatory residents and a hospice waiver capacity of 6. The facility currently provides care for 5 residents. In addition, there is 1 resident receiving hospice services and some of which with a diagnosis of dementia. At approximately 9:30 AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and garage. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen pantry. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 108.3 and 112.4 degrees F at three of three faucets accessible to residents. Two of two fire extinguishers inspected were charged. 8 of 8 Smoke detectors were present and last inspected on 05/20/24. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Continued on LIC809-Ca Continued from LIC809 Medications located in designated closet were found to be secured. LPA conducted a spot check of medications and found all administering and records to be in order. Resident was observed interacting with staff in the common area, watching television and reading for leisure. Two residents were found in there room watching television for leisure. Clients are happy, bathed daily, love the food, and enjoy the home per two clients comments and responses. LPA observed resident on hospice sleeping in their room and with staff checking on resident often. At approximately 11:00AM, LPA reviewed 5 of 5 resident records which were all found to be well organized, thorough and contained the required documentation. At approximately 11:50 AM , LPA reviewed 4 of 4 staff records which were all found to be well organized, thorough and contained the required documentation. Medication records are thorough and contained physician's orders for each resident. One of five residents are receiving Hospice services and the Hospice care plans were up to date for the resident. Administrator, Victoria Gonzales's Administrator Certification 6045724740 is expired as of 3/1/2024. Administrator provided LPA proof of recertification and proof Administrator Certificate is eligible and pending. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (updated with 2nd non-local evacuation site) LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Pest Prevention Services No citations issued during today’s visit.the state’s words, verbatim · CDSS document, May 24, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.