Ailida Retirement Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ivashia Wright conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver, Asuncion Fetalvo, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Administrator Annalisa Blancaflor arrived shortly after. Facility Overview:The facility is a single story building with four(4) residents bedrooms, two(2) bathrooms, one(1) staff room, a dinning room, a family room, a kitchen and a garage. There are no gated pool or firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were in good working condition. LPA observed fire extinguisher to be in compliance with the department's requirements and with an expiration date of 6/25/2026. The water temperature was tested within regulations measuring at 112.2. Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise residents during the visit. The administrator holds a current administrator’s certificate with expiration date of 9/9/2027 and a CPR certification with the expiration date of 12/8/2027. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearance, updated training, and CPR/First Aid certification. Three (3) residents files were reviewed and contained all required documentation. LPA observed first aid kit to be locked and inaccessible to the residents in care. The residents and staff files were inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents medications were securely locked in a cabinet in the kitchen area. LPA reviewed medications for two (2) residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted on 6/30/2025, which did not met department requirements. A Technical violation was issued. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Licensee/Administrator Annalisa Blancaflor.the state’s words, verbatim · CDSS document, Apr 16, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

This Case management– Deficiencies inspection is being conducted by Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Robert Campbell on 01-05-26 for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 18-AS-20260102133403. LPAs met with Licensee Annalisa Olivan-Blancaflor and explained purpose of the visit. During the visit, LPAs observed R1 to be fully bedridden in a non-ambulatory room. Based on observations, record review and interviews , deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative, Annalisa Olivan-Blancaflor.the state’s words, verbatim · CDSS document, Jan 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jan 6, 2026

(a)All facilities shall maintain a fire clearance approved...prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county... This requirement was not met with evidence Based on interviews and records review, R1 was admitted at the facility as a bed bound with maximum assistance in a non-approved room for bedridden. This poses an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: The licensee stated they will make arrangements to move R1 to the approved bed ridden facility by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted case management deficiencies visit to the facility. LPA conducted a visit on 04-15-25 and citations were issue related to the accrued balance of the licensee fees, and storage of medication in their original container. These deficiencies were not corrected by the POC due date nor at the time of the visit. Therefore, the facility is being recited for failure to correct deficiencies. An exit interview was conducted and a copy of this report, 809D, appeal rights was reviewed and provided to Caregiver Adela Antacthe state’s words, verbatim · CDSS document, May 29, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Jun 12, 2025

87465 Incidental Medical and Dental Care(h) 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. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 4 client medications were not in their original container which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 29, 2025

Plan of correction: Licensee will conduct staff training on the regulation cited above and will provide proof of training to LPA by the POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR87156(a) · Plan of correction due date: Jun 12, 2025

87156 Licensing Fees (a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above. LPA observed the facility has not paid their annual licensing fees due on 4/11/2025 and has a current balance of $1,484.00, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 29, 2025

Plan of correction: Licensee reported they will pay their licensing fees and provide proof of correction to LPA by close of business on POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection. The LPA was greeted by Caregiver Adela Entac, notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. The Licensee/Administrator Annalisa Blancaflor joined the visit at a later time. Facility Overview: The facility is a single story building with four(4) residents bedrooms, two(2) bathrooms, one(1) staff room, a dinning room, a family room, a kitchen and a garage. There are no gated pool or firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department's requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in the kitchen and inaccessible to residents. The smoke detector and carbon monoxide detector were in good working condition. LPA observed fire extinguishers to be in compliance with the department's requirements and with an expiration date of April 15, 2026. The water temperature was tested within regulations measuring at 114.6 F Continued 809-C...... Care & Supervision/Administration: Adequate staff were present to supervise residents during the visit. The administrator holds a current administrator’s certificate with expiration date of September 9, 2025 and a CPR certification with the expiration date of May 8, 2025. LPA observed the facility has not paid their annual licensing fees due on 4/11/2025. A citation will be issued. Record Review and Resident/Staff Files: LPA reviewed files for two(2) staff members, confirming criminal clearance, updated training, and CPR/First Aid certification. Two (2) residents' files were reviewed and contained all required documentation. LPA observed first kit to be locked and inaccessible to the residents in care. The residents and staff files were inaccessible to unauthorized individuals. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPA reviewed medications for three(3) residents, confirming that all medications were listed and accounted for. LPA observed medication of one resident not stored in their original container. A citation will be issued. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last emergency drill conducted in 2023, which did no met department requirements. A citation will be issued. All facility exits were clear of obstructions. Deficiencies were cited during the visit per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted, and Appeal Rights were discussed with Caregiver Adela Entac. A copy of the LIC809, LIC 809D and appeal rights, was provided to Caregiver Adela Entacthe state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Required - 1 Year

On 4/8/2024, Licensing Program Analyst, (LPA) Janette Romero arrived unannounced to conduct an annual required inspection at the facility. LPA met with Caregiver, Adela Fetalvo who was informed of the purpose of the visit. During the visit, there was six (6) residents and two (2) staff present. The facility has a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident. The facility has an approved hospice waiver for four (4) residents and LPA was informed there are currently two (2) residents receiving hospice services at the facility. LPA toured the facility's interior and exterior with Caregiver Fetalvo. During the tour, LPA observed the home is clean and furniture is in good repair. LPA observed residents watching television in the living room and sleeping in their rooms. Complaint procedures are posted in the living room. Caregiver Fetalvo tested the smoke alarm/carbon monoxide detectors and LPA observed them to be operational. Indoor and outdoor passageways are free of obstruction. LPA toured the kitchen and observed the facility has more than a 2-day supply of perishable food items and 7-day supply of non-perishable food items. The fireplace in the dining room is adequately screened. Resident bedrooms have the required bedding, furniture and lighting. Resident bathrooms had non-skid mats in the showers. LPA reviewed random staff and resident files. Staff files have the Department's required training records, a criminal record clearance on file and valid first aid certification. Resident files have signed admission agreements and updated physician's reports. Medications are secured in a kitchen cabinet and disinfectants are secured in the garage. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Caregiver Fetalvo.the state’s words, verbatim · CDSS document, Apr 8, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Yolanda Delgado made an visit to the facility to conduct a case management visit due to an 9099D inadvertently created on December 15, 2021 for a complaint visit and needs to be address during todays visit. LPA met with Adela Fetalvo and explained the reason for the visit. LPA Delgado was granted entry. There are six (6) residents in care and two (2) staff on duty at the time of the visit. LPA Delgado toured the facility, along with the caregiver and made observations. There are no imminent health and/or safety concerns observed at the time of visit. LPA Delgado did not observed any health and/or safety hazards inside or outside of the facility at the time of this visit; LPA observed all facility utilities to be on and operating without issue. The LPA assessed the available food supply and observed there was a variety of food types, and the supply exceeds the requirement of a two day supply of perishable foods and a seven day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. For December 15, 2021 visit two (2) deficiencies were observed and civil penalties of $500 were cited at today's visit. An exit interview was conducted and a copy of this report, LIC 809D, LIC421BG and Appeal Rights was provided to the Caregiver.the state’s words, verbatim · CDSS document, Mar 12, 2024

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87632(d)(2) · Plan of correction due date: Dec 15, 2021

CRIMINAL RECORD CLEARANCE: All individuals subject to criminal records review...shall prior to working, volunteering...in a licensed facility (1) obtain a California clearance...as required by the Department. This requirement was not being met as evidenced by: LPA Delgado conducted interviews and records reviewed that 1 of 6 staff member (Staff #6) was not fingerprinted cleared and associated to the facility, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 12, 2024

Plan of correction: Administrator states they will not retain staff #6. Administrator will ensure a criminal background clearances and associate to the facility for future employees prior to working at the facility. LPA did not observe staff #6 on premises on 12/15/2021. Civil penalities of $500 dollars will be issued.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(1) · Plan of correction due date: Dec 15, 2021

HOSPICE CARE WAIVER: The licensee shally notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or a resident already receiving hospice care services. This requirement was not being met as evidenced by: LPA Delgado observed, interview and review of records revealed that the Administrator did not notify CCLD that 4 of 6 residents were on Hospice in writing within 5 days, which poses an immediate Health, Safety, or Personal Rights risk to person in care.the state’s words, verbatim · CDSS document, Mar 12, 2024

Plan of correction: Administrator will submit in writing to CCLD by 12/17/2021 of current residents on Hospice. LPA received Hospice notification for residents on 12/15/2021.