Amazing Home

Type of visit: Case Management - Annual Continuation

To complete annual inspection of 10/23/25, LPA Jeung reviewed client and staff records. Deficiency of the California Code of Regulations, Title 22, is observed and cited on a following page.the state’s words, verbatim · CDSS document, Nov 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(h)(1-2) · Plan of correction due date: Dec 2, 2025

REAPPRAISALS The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every 12 months, either in person or by video appointment. Documentation... shall be added to the resident's record... resident's refusal to receive an annual routine visit... shall be added to the resident's record. This requirement is not met, as 3 out of 5 clients are missing current MD assessments. Licensee failed to ensure that annual MD reports are maintained, which poses a potential health, safety or personal rights riskthe state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Updated MD assessments for clients #2, #3, #5--or documentation of their signed refusal-- will be sent to CCLD BY DUE DATE.

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds--including detached storage shed--for this 6 bed RCFE, consisting of 4 client bedrooms, staff room with 2 beds, 2 full bathrooms, kitchen, living/dining room, and 2-car garage, used by staff for rest and office space. There are no accessible bodies of water or fire safety hazards observed. Hot water temperature is tested at 107 degrees in common bathroom. Food supply and first-aid kit are inspected, and hygiene items for general use are maintained. An Emergency Disaster Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. One resident is receiving hospice services at this time. Client and staff files will be reviewed at a later date, due to time constraints, There are 5 RCFE certified administrators associated with facility: Necia Conde (x 10/26), Iress Caguiat (x 9/27), Leandra Salvador (x 2/26), Ivy Lagonero (x 6/26), Renalin Salvadico (x 3/26). Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes- 1 page.the state’s words, verbatim · CDSS document, Oct 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Oct 23, 2025

STORAGE SPACE & ACCESS Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances..., matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage, and are not left unattended... This requirement is not met, as liquid detergents, liquid bleach, and liquid Comet cleaner are stored in hallway closet and client bathroom, accessible to clients. Licensee failed to ensure that cleaning chemicals are secured and inaccessible to clients.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Co-aministrator Salvador relocated liquid detergents, bleach and cleaner to secure storage in LPA's presence. Deficiency corrected and cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 6, 2025

MAINTENANCE AND OPERATION The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met, as there are discarded furnishings in backyard, which poses a potential health, safety or personal rights risk to clients in care. Licensee failed to ensure that facility grounds are free of debris--metal bed frame, metal chairs, mattress, bathtub.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Discarded furnishings will be removed from premises, and proof of correction to be sent to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds--including detached storage shed--for this 6 bed RCFE, consisting of 4 client bedrooms, staff room with 2 beds, 2 full bathrooms, kitchen, living/dining room, and 2-car garage, used by staff for rest and office space. There are no accessible bodies of water or fire safety hazards observed. Hot water temperature is tested at 108 degrees in common bathroom. Food supply and first-aid kit are inspected, and hygiene items for general use are maintained. Client files are reviewed, An Emergency Disaster Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as required staff records. There are no hospice services being provided at this time. There are 5 RCFE certified administrators associated with facility: Necia Conde (x 10/24), Iress Caguiat (x 9/25), Leandra Salvador (x 2/26), Ivy Lagonero (x 6/24), Renalin Salvadico (x 3/26). The following forms are requested to be completed and returned to CCL by 10/29/24: • LIC 308 Designation of Administrative Responsibility • LIC 309 Administrative Organization • LIC 500 Personnel Report • Facility Sketch (including dimensions) • Proof of control of property (signed and dated lease agreement) • LIC 9282 Infection Control Plan (page 5 signed and dated) - Proof of current liability insurance The (LIC 610E) Emergency Disaster Plan--9 pages, with signed and dated page 9-- is given to LPA today. Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes--3 pages.the state’s words, verbatim · CDSS document, Oct 15, 2024