Agape Orange Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry by staff at 1pm. LPA spoke with Administrator (AD) Natalia Surgent, who was out-of-town, and explained the purpose of the visit. AD stated AD Daniela Usurelu was on her way to assist LPA with the visit. The facility is a two-story residential home with a capacity of six non-ambulatory residents of which one may be bedridden and has a hospice waiver for three residents. Currently there are six residents in care, none of which are bedridden. Three residents receive hospice services. During the visit LPA toured the property and observed that sharps and knives were secured in a locked drawer. Chemicals and hazardous materials were stored and secured underneath the sink. Kitchen appliances such as the stove, dishwasher and microwave were in working order. LPA observed there were two days of perishable supplies in the refrigerator and seven days of non-perishable food items on hand. The facility was 77 degrees Fahrenheit and was clean with no odors detected. LPA inspected the smoke and carbon monoxide detectors and they are connected and operational. LPA observed three fire extinguishers that were charged and inspected on August 11, 2025. The facility's last fire drill was on June 26, 2026. LPA observed hallway night lights and there are cameras in common areas with no audio. All exit doors had auditory devices. LPA tested the hot water temperature in three of three bathrooms and the temperatures ranged between 105.2 to 111.0 degrees Fahrenheit. All bathrooms had grab bars and non skid flooring. Resident bedrooms were clean and had all of the required furnishings and (Continued on LIC 809-C) (Continued from LIC 809) linens. The licensee lives on the second floor and was out-of-town. All entrances to the second level were locked so there is no access for residents or staff. LPA observed the See Something, Say Something (PUB 475) and Long Term Care Ombudsman posters posted with the Emergency Disaster Plan, Personal Rights, Resident Council meetings, activities and the weekly menu. Facility liability insurance is current. LPA toured the exterior of the property and there were no hazards or obstruction in pathways. LPA observed shaded seating areas and there was ample space for outdoor activities. The exterior gate was in working order. LPA audited the centrally stored medications for six of six residents. Per review, medications are being given as prescribed. The facility had all the required elements in the First Aid Kit and had a First Aid book on-site. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on March 30, 2028. LPA reminded AD regarding licensing fees due to avoid late fees and provided payment information. Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Daniela Usurelu, Administrator (AD) and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.the state’s words, verbatim · CDSS document, Aug 7, 2026

Type of visit: Required - 1 Year

On August 29, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Andreea Moldovan arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents of which one (1) may be bedridden with approved hospice waiver for three (3) residents. Currently, there are three (3) Hospice residents present during today’s visit. Facility has six (6) residents. This is a two story with an attached garage home. The facility has five (5) bedrooms (four private resident rooms, one shared resident room), two full bathrooms and one half bathroom. First floor of home residents have access to. Second story is for Licensee use and residents don’t have access to. LPA conducted a tour of the physical plant accompanied by Administrator Andreea Moldovan, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 106.3 to 107.7 degrees F. A comfortable temperature of 71 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Secured storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. CONTINUED ON 809C The kitchen was inspected, and sufficient two day perishables and seven day non-perishable food was maintained adequately. Facility has supply of emergency food and water. Facility has three fire extinguishers which were mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During visit LPA reviewed six resident files. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has a supply of Personal Protective Equipment (PPE). LPA observed mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on July 6, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 10/1/2024 – 10/1/2025. A review of six residents (R1-R6) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Andreea Moldovan # 7008986740 - Expiration 2/7/2026. No deficiencies during this inspection visit. An exit interview was conducted with Administrator Andreea Moldovan, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit before entering the facility. Staff called Licensee/Administrator (AD) Natalia Surgent who arrived and was present for the remainder of the visit. AD Surgent has a current administrator’s certificate that expires 02/10/26. Around 9:00am LPA Haley began the tour of the facility with. Right next to the front door is a lock closet used to store staff files, resident files, resident medications, and a first aid kit with all the required elements. All six clients were present during the visit. All resident bedrooms were clean, well organized, and had all necessary requirements: nightstand, chair, lamp and storage space. Resident bathrooms were clean and organized. Hot water temperature was measured in the range of 109.5 – 111.5 degrees Fahrenheit. There’s a small office area in the living room with a filing cabinet with files of former employees and former residents. Dominoes and other activity items were observed right behind desk in the office area. There’s a fully charged fire extinguisher mounted on the wall right behind the office area. The kitchen was clean and organized. All knives and sharp objects were locked in a cabinet near the stove. All burners on the stove were operational. The facility has a two-day supply of perishable food items and seven-day supply of nonperishable food items. The garage has clear walking paths and is used to store various facility items. Hazardous chemicals are locked in a cabinet in the garage. There’s a laundry area with a washer and dryer, and an additional deep freezer and refrigerator with an additional food supply. An emergency supply of water was observed. Continued on LIC809C The backyard was clean, organized, and walkways are free of obstruction. There’s a shaded patio with a couple tables and chairs. There’s a locked shed used to store miscellaneous items. The side exit gate is self-closing and self-latching. During the visit, interviews were conducted with two staff, and one resident. A file review and medication audit was conducted for six residents, and four staff files were reviewed. No bodies of water observed. Smoke and carbon monoxide detectors tested and are operational. Two fully charged fire extinguishers were observed mounted on the wall in different areas of the facility. No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 21, 2024