A Peaceful Home of Covina

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted the required annual inspection. LPA arrived unannounced and met with Staff, Angel Lisa Ayento, who allowed entry. The purpose for the visit was explained. The facility is licensed for residents aged 60 and over. The fire clearance is approved for (5) non-ambulatory residents in rooms #1, 2, 4, and 5. Bedroom 3 is approved for (1) bedridden. There is a hospice waiver approved for 6 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 5 non-ambulatory residents residing at the facility. Bedroom #3 is the designated room for (1) bedridden resident only. The facility has enough for liability insurance covering injuries to residents and guest. Physical Plant & Environment Safety: There are 5 bedrooms, 2 bathrooms, living room, dining room, kitchen, and an attached garage. The garage has an additional room allotted for a live-in staff room. Facility has operable smoke and carbon monoxide combo detectors located in each room and hallway. Knives, cleaning solutions, and disinfectants are locked in the cabinets. LPA measured the hot water temperature in the bathrooms, hot water temperature in the bathrooms were measured between 105-120 degrees F. CONTINUED 0N 809C............ Staffing: There appears to be sufficient staffing at the facility. The administrator's (Elizah Arganos expires10/22/2026). Staff employed are all over the age of 18. Personnel Records-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food is properly stored in the refrigerator to avoid cross contamination. Incidental Medical & Dental: The medications are centrally stored and in their original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. During the visit today, LPA reviewed all six (6) residents' medication and observed the MAR to be completely filled out according to the date administered. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training on appropriately caring for residents with dementia, those on hospice, and receiving oxygen. No Smoking - Oxygen in use signs are posted on the doors of residents using oxygen. During the visit today, no deficiencies were observed. An exit interview was held.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Tao and DeLeon conducted an unannounced annual inspection visit. LPA met with Elizah Arganosa, Administrator assistant and Thang Duong, Licensee. The facility is licensed to serve age range from 60 years old and over, including five (5) non-ambulatory residents in room#1, 2, 4, and 5; one (1) bedridden in room#3. Facility has hospice care waiver for six (6) residents. The annual fees were current. LPAs explained the purpose of today's visit and the inspection to the administrator. During the visit, Care tools, staff/resident interviews and physical plant were conducted; food supply, staff/residents files and medications were reviewed. This facility is located in a residential neighborhood, single story house, with (5) bedrooms, (1) bathrooms, living room, dining area, kitchen, and a car garage. The facility has (4) single rooms and (1) shared room for clients. There will be no live-in staff at the facility. The yard has a shaded area and free of debris/hazard. Bathrooms are clean and operational. Sufficient supply of perishable and non-perishable foods. Adequate linen and personal hygiene supply. Smoke detectors are combined with carbon monoxide detectors and are operable and in compliance. The last Fire/ Emergency Drill was conducted on 1/1/2025. Auditory devices are operable. Medications are centrally stored, and locked. Residents and staff records have required documentation. Hot water temperature is measured at 118.4 degrees Fahrenheit. Administrator certificate is current and expires on 10/22/2026. No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit conference was conducted and report LIC 809 were provided.the state’s words, verbatim · CDSS document, Jan 28, 2025

Allegation investigated: Staff handle resident in care in a rough manner. Staff do not ensure that resident's toileting needs are met while in care.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegations listed above. LPA arrived unannounced and met with the Assistant Administrator, Elizah Arganosa. The purpose for the visit was explained. LPA obtained copies of the staff and resident rosters. Interviews were held with 4 Staff and 5 Residents. The investigation revealed the following: Allegation – Staff handle resident in care in a rough manner. Staff interviewed stated they received training on properly transferring of residents. They stated they handle residents as gently as possible and have not seen other staff be rough with residents. LPA interviewed 5 residents and 4 out of 5 stated staff handle them carefully while assisting them during transfer and other activities. They have not seen staff being rough with others either. Unsubstantiated Allegation – Staff do not ensure that resident’s toileting needs are met while in care. Staff interviewed stated they check on resident with incontinence every 2 hours. If the diapers need to be changed, they will do so immediately. Staff stated residents have call buttons and will let them know as well if their diaper is soiled. Staff denied leaving residents to sit in soiled diapers during the day or night. 4 out of the 5 residents interviewed indicated that the staff checks on them and change their diapers if needed. They are not left sitting in a soiled diaper. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with E. Arganosa. A copy of this report along with the appeal rights was provided.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 28-AS-20241101111849

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 01/16/2024. LPA was met by Administrator Elizah Arganosa and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which five (5) may be non-ambulatory and has a hospice waiver approved for six (6). LPA OBSERVATIONS: The facility is a single-story dwelling located in a residential neighborhood and consist of five (5) resident bedrooms, two (2) bathrooms (one shared and one private), kitchen, dining room, living room, attached garage, front yard, and backyard. Front Yard: Front yard is well maintained, and no hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives, sharps and disinfectants to be inaccessible to residents. Dining Room/Living room/: Dining room was observed to contain one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed nearby thermostat in this area to read 77-degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1-5: LPA Ramirez inspected five (5) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. LPA Ramirez observed auditory devices to be operable in all resident bedroom exits. Fire clearance is approved for (5) non-ambulatory residents in rooms #1, 2, 4, and 5. Bedroom #3 is approved for (1) bedridden. SEE 809-C Bathrooms 1-2: Water temperature in bathrooms was within 105–120-degree F. LPA Ramirez observed grab bars and non-slip mats in shower and grab bars near toilet. Backyard: No hazards were observed. Plenty of shade and seating was observed. Emergency Drills: Last two (2) documented fire drills were conducted on 01/02/204 at 9:30 am & 12/07/2023 at 2pm. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed five (5) personnel records. Documented proof of required annual training was present, however, the training did not document dementia hours. LPA Ramirez will issue Technical Violation. Administrator’s Certificate for Elizah Faye Arganosa with an expiration of 10/21/2024. Resident Records: Five (5) resident records were reviewed. LPA Ramirez observed five (5) resident medications and Medication Administration Records (MAR). Liability Insurance & Infection Control Plan: LPA Ramirez obtained a copy of liability insurance during visit. LPA Ramirez observed updated infection control plan. Technical violations are being cited. A copy of this report, LIC 9120 and appeals rights was provided via email.the state’s words, verbatim · CDSS document, Jan 16, 2024

The state marks this report as 8 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.