Above & Beyond RCFE

Type of visit: Required - 1 Year

On this day, March 26, 2026, at 4:10 pm., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Larry Poblete and LOurdes Deocampo, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee. Licensee and Max 'Mike' Neri, administrator (ADM) arrived at around 4:20 pm. LPA started the inspection with Larry Poblete and continued with Max Neri. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has 2 in 1 smoke and carbon monoxide detector that was tested and observed in operating condition during today's visit. Hot water temperature in the common bathroom was tested an measured at 117 degrees Fahrenheit.. Fire extinguisher was observed fully charge with tag showed serviced March 16, 2026. LPA observed the following: -at 4:16 pm, unlocked central storage for medications. -at 4:19 pm, unlocked scissors in the kitchen drawer. -at 4:25 pm, Cortisone ointments in unlocked staff room. -at 4:27 pm, bleach and Lysol spray in unlocked cabinet in residents' ensuite bathroom. -at 4:28 pm, shower room in ensuite bathroom with mildew. ...continued on 809C (page 2) -at 4:35 pm, Calmoseptine ointments in one of the residents' room. -Staff (S1) who started working on March 8, 2026 is not fingerprint cleared. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section #87355(e)92) for staff who is not fingerprint cleared and will continue for $100.00/day until corrected, and for repeat violations of section #'s 87309(a) and 87309(c) within 12 month period. Failure to submit proof of corrections by plan of correction due dates for other deficiencies cited may also result in civil penalties. Deficiencies, plan and proof of corrections, and civil penalties were discussed with the administrator. Due to time constraint, LPA will come back to continue the inspection. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalties, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Mar 26, 2026

Type of visit: Case Management - Annual Continuation

On this day, 4/08/25, at 11:45 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on 3/28/25. LPA met with staff, Larry Poblete, Evangelien Porter and Gerald Cayle Garcia, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, who arrived at around 12:25 pm. Max Neri, administrator (ADM) arrived at around 1:00 pm. Disaster drill record on file was dated 1/10/25. There's no record as proof drills were conducted on previous quarters. LPA reviewed 5 staff and 5 residents' files. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 12:20 pm, staff (S2) does have LIC501 Personnel Record, LIC503 Health Screening, TB test and 40 hours required training on file. -at 12:35 pm, staff (S4) is not associated to this facility. Does not have LIC503 Health Screening, TB test, required 40 hours training and first aid certificate on file. -at 12:40 pm, staff (S5) does not have LIC503 Health Screening, TB test, required 40 hours training and first aid certificate on file. .......continued on 809C -at 1:05 pm, resident's (R1) LIC602A indicated ambulatory but resident has major neurocognitive disorder. LIC625 on file is over a year old. -at 1:17 pm, resident's (R2) LIC602A on file dated 2023 indicated bedridden but R2 was observed able to ambulate using walker. LIC602A indicated major neurocognitive disorder. LIC625 is over a year old. -at 1:25 pm, resident's (R3) LIC625 Appraisal/Needs Services Plan not properly filled-up - incomplete; page 2 blank; page 3 no care plan. No doctor's order on file for half bed rails. -at 1:40 pm, resident's (R4) LIC602A is over a year old; does not have Pre-Admission Appraisal and LIC625 Appraisal/Needs and Services Plan. Half bed rails does not have doctor's order on file. -at 2:10 pm, resident's (R5) 2 medications received by the facility not properly recorded on LIC622. Administrator to submit current/updated copies of the following documents by April 22, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610D Emergency Disaster Plan (9 pages). 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of corrections were discussed with ADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Required - 1 Year

On this day, March 28, 2024, at 4:10 pm., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Virginia Rulete and Blesilda Yamat, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, and Max 'Mike' Neri, administrator (ADM). The licensee authorized to have the staff to be with LPA in touring the facility. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were observed in operating condition. Hot water temperature in the common bathroom was tested. Fire extinguisher was observed fully charge with tag showed serviced 3/06/25. LPA observed the following: -at 4:25 pm, medications in the refrigerator in unlocked garage. -at 4:27 pm, unlocked kitchen shears and medication (Aspirin) in the kitchen cabinet. -at 4:28 pm, kitchen cabinets where sharps and cleaning supplies are kept do not have an appropriate lock. -at 4:30 pm, Vitamins and perineal skin protector in cabinet without lock in the area adjacent to the dining area. ...continued on 809C (page 2) Page 2 -at 4:42 pm, shaving cream in one of the residents' rooms. -at 4:43 pm, razor in food tray in another resident's room. -at 4:44 pm, disinfectant and sanitizing sprays in the common bathroom. -at 4:50 pm, hot water in the common bathroom was at 134.1 degrees Fahrenheit. -at 5:02 pm, Isopropyl alcohol and urinary tract infection (UTI) pain reliever in the drawer in another residents' room. -at 5:04 pm, piece of metal, mattress, bed frame and bed rail in the backyard. -at 5:05 pm, rake outside the storage in the backyard. -staff (S1) is fingerprint cleared, however, not associated to this facility. Administrator to submit copies of the following updated/current documents by April 11, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in additional civil penalties. Deficiencies and plan and proof of corrections were discussed with licensee and ADM over the phone. Licensee authorized Virginia Rulete to sign and receive this report. Due to time constraint, LPA to come back to continue the inspection. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Mar 28, 2025

Type of visit: Required - 1 Year

.On this day, March 23, 2024, at 11:05 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Marlyn Joaquin and Raul Pangilinan, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, who authorized Marilyn Joaquin to be with LPA to start inspection. Licensee and Max 'Mike' Neri, administrator, arrived at 11:35 a.m. and 11:40 a.m.. respectively. Facility submitted the LIC9282 Infection Control Plan on June 29, 2022. LPA started the inspection with Marlyn Joaquin, and continued with the licensee and administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were observed functional. Hot water temperature in the ensuite bathroom was tested. Fire extinguisher was observed fully charge with tag showed serviced February 13, 2024. Facility disaster drill records checked. LPA reviewed 5 residents and 4 staff files, and interviewed 2 staff and 2 residents. Medications were checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 11:19 a.m., unlocked medication cabinets. -at 11:20 a.m., residents medications in the refrigerator in the kitchen. ...continued on 809C (page 2) Page 2 -at 11:24 a.m., knives in unlocked kitchen cabinet, and scissors and pizza cutter in kitchen drawers without lock. -at 11:32 a.m., scissors in drawer without lock in the living room. -at 11:34 a.m., medication in unlocked staff room. -at 11:41 a.m., Aleve, Glucosamine. Bengay in one of residents rooms. -at 11:52 a.m., Lysol, Windex, Barbasol in cabinet without lock in the ensuite bathroom. -at 11:55 a.m., hot water at 125.1 degrees Fahrenheit. -at 11:59 a.m., peritoneal cleansers and ointments in the common bathroom.. -at 12:01 p.m., trash cans without lid in one of the residents' rooms and living room. -at 12:06 p.m., Oxygen tanks, pails of paint in unlocked storage in the backyard. -at 12:30 p.m., disaster drills not conducted quarterly; records showed conducted on 1/11/22 and 1/11/24. -at 2:00 p.m., staff (S3) has no LIC503 Health Screening & TB test result on file, Total hours of training on file is only 22 hours. -at 2:30 p.m., staff (S4) not fingerprint cleared and associated. -at 3:15 p.m., resident (R1) LIC602A Physician's Report is over a year old. No LIC625 Appraisal/Needs and Services Plan & doctor's order for half bed rails. -at 3:50 p.m., R2's half bed rails no doctor's order on file,, -at 4:05 p.m., no doctor's order on file for R3's half bed rails. -at 5:00 p.m., R1's 3 medications not recorded on LIC622 Centrally Stored Medication and Destruction Record, Dates filled of other medications incorrectly recorded. -at 5:35 p.m., R2 has 21 medications on facility's hand but there's only 18 on doctor's order, Facility is only giving only 11 medications of which one (muti vitamins) is given twice daily when order is only once daily. Medications received were not properly recorded on LIC622. -at 7:00 p.m., R3 has no LIC622 on file. Doctor's order for calcium carbonate-Vit D3 (600 mg-12.5 mcg(500 unit) but the medication on facility's hand os 600 mg-10 mg (400 unit).No doctor's order for half bedrails. -at 7:05 p.m., no doctor's for R4's half bed rails. ....continued on 809C (pge 3) Page 3 Administrator submitted on this day the following updated/current documents: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500.00 civil penalty is assessed for staff not fingerprint cleared. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in additional civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator and licensee. Exit interview conducted. Appeal Rights, LIC421BG Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Mar 23, 2024