Amethyst Home 2

Type of visit: Required - 1 Year

On April 3, 2026, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Nicetas Bunning. LPA Kim met with Administrator (ADMIN) Manuel Abadines and explained the purpose of the visit. ADMIN Abadines stated that he could not stay for the visit and that Staff Maria Celia Sangrador could sign on behalf of the facility. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom in the garage, two (2) bathrooms, two (2) living areas, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 110.1 degrees F to 113.1 degrees F. A comfortable temperature of 75 degrees F maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-463-4634) and a tablet that has internet access that has video conferencing capability that both remain available. Emergency drills are conducted quarterly. First aid kit is maintained and contains all the necessary elements. Fire extinguisher is located in the dining area. LPA Kim conducted an audit of resident files (R1-R3), staff files (S1-S6), and medication and medication administration record. LPA observed S1, S2, and S3 did not have a current and valid CPR and First aid training available on file at the time of the visit. LPA observed S3 did not have a LIC503 or TB testing available on file at the time of the visit. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed S1, S2, and S3 did not have a current and valid CPR and First aid training available on file at the time of the visit. LPA observed S3 did not have a LIC503 or TB testing available on file at the time of the visit.. An exit interview was conducted, and a copy of this report, LIC811, LIC809D, and appeal rights were provided to Staff Maria Celia Sangrador.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Required - 1 Year

On April 4, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Nicetas Cardente. Administrator (AD) Manuel Abadines arrived at the facility and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom in the garage, two (2) bathrooms, two (2) living areas, dining area, kitchen, outdoor covered patio, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with CG Cardente. AD Abadines took over the tour around 8:40 AM. There were no bodies of water or obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 109.6 degrees F to 110.8 degrees F. A comfortable temperature of 73 degrees F maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714-463-4634) and a tablet that has internet access that has video conferencing capability that both remain available. Last emergency drill was conducted on March 10, 2025 and conducted quarterly. First aid kit is maintained and contains all the necessary elements. Fire extinguisher is located in the dining area. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S6), and medication and medication administration record that were all in order and complete. Deficiencies were cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). Staff #6 (S6) was at the facility on April 3, 2025, and April 4, 2025, without finger print background clearance as a volunteer. S6 left the facility around 9:30 AM on April 4, 2025. The staff room added two walls in the garage that is not reflected in the original facility sketch. Staff #1 (S1) states the room was added to be a staff room in the facility. See LIC809D. A civil penalty was assessed during today’s visit. See LIC421BG. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Manuel Abadines.the state’s words, verbatim · CDSS document, Apr 4, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection. LPA arrived and was greeted and granted entry by Administrators Manuel Abadines and Maria Cecilia-Sangrador. An application to operate a Residential Care Facility for the Elderly (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden residents was received by Community Care Licensing (CCL) on 7/20/2023. The facility is a one-story home with three shared resident bedrooms, two bathrooms, two living rooms, dining room, kitchen, staff lounge, laundry room and backyard. Client Bedrooms have all the necessary requirements including bed, chair, storage for clothing and ample lighting. LPA observed all windows were screened. All bathrooms have working plumbing and designated hand washing posters. Hot water measured between 119 and 120 degrees Fahrenheit. LPA issued a technical assistance advising the ADs to maintain a water log to ensure proper temperatures continue to be maintained. LPA observed the fire extinguisher to be fully charged as indicated by the arrow pointing in the green zone. The service tag indicates the extinguisher was serviced on May 2, 2023. Medications and First-Aid Kit will be locked in a lock box in a closet in the hallway. Resident & Staff Files will be locked in a closet in the living room. The fire clearance was approved by a fire inspector of Orange County Fire Authority on 7/31/2023. Extra hygiene supplies and linens will be stored in a closet in the hallway. LPA observed space in the garage where the ADs will keep chemicals, cleaning solutions, laundry toxins and disinfectants. ADs stated they will purchase additional locks to ensure all toxins remain inaccessible to residents. Emergency Phone Numbers, Exit Plan, Activity Calendar and Menu are all posted and available for review. LPA observed other necessary postings in the living room. Smoke and Carbon Monoxide detectors are stationed throughout the home and are wired together. Both types of detectors were tested and noted as operational. Operational appliances include a gas stove, oven, two refrigerators, dishwasher, microwave, washing machine and dryer. LPA reviewed and provided Administrators with the Component III presentation to offer information and resources regarding maintaining facility compliance. The designated ADs was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated AD.the state’s words, verbatim · CDSS document, Mar 28, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Manuel Abadines, CEO/Administrator Interview Method: Telephone interview On 3/15/24, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 15, 2024