Ameridge Residential Care

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Angelo Buenaventura and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 10:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 4-bedroom, 3-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA and AD observed 2 staff and 5 residents present at the facility. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 110 and 113 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 7:45AM, LPA reviewed 5 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 5 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on observation, the facility's west backyard exit gate, which is marked as the exit path for emergencies on the fire clearance, was locked with a deadbolt and the facility's east backyard exit gate also had a deadbolt on it, although it was not locked; based on observation, the facility's fire extinguishers were purchased over a year ago and have not been inspected; based on documents, S3's health screening does not indicate whether or not they have TB; based on documents, the first aid certificates for S2 and S3 expired about a month ago; based on documents, S2 and S3 only have 2.5 hours of medication training in the past year; based on documents, the physician's reports for R1, R2, and R3 are on the old form and do not contain required information, including behavioral expressions; based on documents, the appraisals for R1 and R3 have not been updated in over a year; based on observation and admission, the licensee could not locate the facility's emergency disaster plan digitally and admitted there is no printed copy at the facility as required; and based on documents and admission, the licensee is unable to provide records showing quarterly emergency disaster drills. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Mar 17, 2026

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Angelo Buenaventura and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 8:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 4-bedroom, 3-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 5 residents present at the facility. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 114 and 116 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the hallway, after corrections. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:30AM, LPA reviewed 5 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 5 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on documents, the facility does not have an Infection Control Plan; based on observation, the facility's fire extinguishers were purchased in 2022 and have not been inspected since; based on observation, the licensee did not ensure toxins, including bleach, were inaccessible in the non-lockable garage; based on Guardian records and admission, Staff #1 (S1) Mileah L Evangelista has been working at the facility for over a year and is background cleared, but is not associated to the facility; based on documents, the licensee did not ensure 2 out of 2 staff had documented medication training; based on documents and admission, the licensee has not been conducting emergency disaster drills; based on observation and admission, Resident #1 (R1) had a full bedrail on their bed but is not on hospice; and based on admission and documents, the facility has a hospice waiver for 2 but currently has 3 residents on hospice. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jan 30, 2025

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct an annual visit. LPA was greeted and granted entry into the facility by Caregiver Nero Kaw and explained the reason for the visit. Administrator/Licensee Angelo Buenaventura arrived at the facility at 10:30 am. The facility is licensed as a 4 bedroom 3 bathroom facility, 4 residents rooms and 1 resident bathroom and 1 staff bathroom. LPA Mendivil toured the facility with staff Nero at 9:10am. LPA Mendivil observed a fifth room, which contains a bed, dresser and personal affects of a staff member. LPA Mendivil observed all residents rooms to contain all required elements including: bed, dresser/closet space, lamp and chair. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 115.1 and 120.5 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 9:40am, . Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. LPA observed emergency water supply on-site. LPA reviewed the emergency disaster plan during the visit. Administrator stated the last emergency drill conducted was prior to last CCLD visit in 2021. Facility provides activities in the form of music, coloring and puzzle activities. CONT ON LIC 809C DATED 02/13/2024 At 10:00am, LPA reviewed 6 resident files and 5 staff files. Resident files contained required documents including admission agreements. LPA observed the residents files in 6 out of 6 did not contain updated physician reports and resident appraisals. Staff files reviewed contained required documentation of health screen/TB, criminal record clearance. At 11 AM, LPA reviewed medication storage and administration. LPA observed Medication Administration Records to have medication signed off until 2/18/2024, based on Administrator the facility staff pre-pours medications for the week. Facility is licensed for 6 non ambulatory residents and a hospice waiver for 2 residents. LPA observed facility to have 1 bedridden resident and 4 residents on hospice. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Feb 13, 2024