Andrea's Elderly Care Facility #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Administrator, Lerma Espiritu and stated the purpose of today's visit. LPA Rai observed 3 staff and 5 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. The basement was locked and was used for storage and not habitual space. LPA Rai toured the facility to include 5 resident rooms, living room, dining room, kitchen and garage. 5 Out of 5 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 105.6 - 107.8 degrees F. Fire extinguisher was observed and inspected on 10/07/2025. LPA Rai observed a complete first aid kit at the facility. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Lerma Espiritu and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Aug 19, 2026

Type of visit: Required - 1 Year

On 8/25/2025, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced annual visit. LPA met with Administrator, Lerma Espiritu and explained the purpose of the visit.. During visit, LPA toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. Facility is a single story home with four resident rooms. While touring the facility it was observed that the room temperature was at 69 deg F. The facility is observed to be clean, odorless, and well maintained. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill will is done quarterly. Four resident records and four staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. Licensee to email Administrator Certificate and Liability Insurance. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

Allegation investigated: Staff handles resident in a rough manner. Staff speaks inappropriately to resident.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator and stated the purpose of today’s visit. On 7/29/2024, the Department received a complaint with the above allegations. On 8/8/2024, the Department conducted an initial investigation at the facility. Continuation on LIC 9099-C, Page 1 of 3. Unfounded Page 2 of 3. Staff handles resident in a rough manner. It was alleged facility staff are rough when they clean resident (R1). On 8/8/2024, the Department interviewed 4 staff (S1-S4). Four out of four staff stated the staff are not rough when they clean R1. Three out of the four staff interviewed provide direct care to R1. Three out of three staff stated they are not rough when they clean resident (R1). All three staff stated they are gentle with R1. All three staff stated they follow R1’s directions when they provide care, so the staff are not rough. On 8/8/2024, the Department interviewed 5 residents (R1-R5). Three out of five residents did not answer LPA’s questions or refused to be interviewed. Two out of two residents stated they receive care and assistance from the facility staff and the staff are not rough with them. Based on review of staff training in 2024, staff have received the following training including Sexual Harassment & Abusive Conduct Prevention Training. Staff speaks inappropriately to resident. It was alleged facility staff are verbally abusive to resident (R1) but details about the verbal abuse incident were not provided. On 8/8/2024, the Department interviewed 4 staff (S1-S4). Four out of four staff stated they staff do not use inappropriate words to the resident. All four staff stated R1 is hard of hearing and staff will speak loudly to R1. Four out of four staff stated they do not see or hear other facility staff speaking inappropriately to resident. On 8/8/2024, the Department interviewed 5 residents (R1-R5). Three out of five residents did not answer LPA’s questions or refused to be interviewed. Two out of two residents stated they receive care and assistance from the facility staff and the staff are not rough with them. Page 3 of 3. Based on review of staff training in 2024, staff have received the following training including Sexual Harassment & Abusive Conduct Prevention Training. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 21, 2024 · control 26-AS-20240729100816

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Back-Up Administrator/Lead Staff, Lerma Espiritu. LPA Rai observed 2 staff and 6 residents at the facility. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai toured the basement of the facility and observe the space being used as storage and not habitual space. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the resident bedrooms. 5 out of 5 resident bedrooms had available bedding, drawers, and functioning lights. LPA Rai reviewed the facility sketch on file as well as the facility sketch posted on the bulletin wall at the facility, which describe the floor plan to have 4 bedrooms, not 5 as observed during visit. LPA Rai spoke with Licensee, Felina Roque who stated the 5th bedroom was added to the facility and they have a city permit to build the room. LPA Rai requested for Licensee Felina to submit the updated facility sketch. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 105.4 degrees F - 105.7 degrees F. The water temperature in the kitchen sink was 105.9F. Fire extinguisher was observed and inspected on 10/10/2023. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drills was conducted on 07/08/2024 and 07/10/2024. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai reviewed facility records for 2 staff and 2 residents. LPA Rai reviewed resident medications and central stored medication records. During visit, LPA Rai observed 5 out of 5 resident beds had attached half-bed rails. LPA Rai reviewed resident files and observed a written order to use half-bed rails for mobility. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Back-Up Administrator/Lead Staff, Lerma Espiritu and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 8, 2024

Allegation investigated: Staff member yells at resident in care.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with Licensee, Felina Roque and stated the purpose of today’s visit. During visit, LPA Rai observed three staff members and 6 residents in the resident rooms. On 3/1/2024, the Department received a complaint with the above allegations. On 3/6/2024, the Department conducted an initial investigation at the facility. It was alleged the facility staff were yelling at resident (R1) when R1 requests for help. Continuation on LIC 9099-C, Page 1 of 2. Unfounded Page 2 of 2. On 3/6/2024, LPA Rai conducted interviews with 2 staff (S1-S2). S1 and S2 assist resident with care and supervision, and they have stated they do not yell or shout at the residents at the facility. They stated R1 is hard of hearing and staff will speak loudly to R1. 2 out of 2 staff stated they did not see or hear other facility staff yell at the residents. On 3/6/2024, LPA Rai conducted interviews with 5 residents. 3 Out of 5 residents were not able to verbally communicate with LPA Rai. LPA Rai was able to interview 2 residents (R1-R2). R1 stated S1 yells at him/her but “its not his fault, it’s China zodiac sign’s fault that R1 is mad”. R1 stated staff are not yelling at him/her because R1 cannot hear and needs staff to raise their voices. R2 stated the staff do not yell but the residents are yelling at the facility staff. R2 stated the staff “treat me nice” and R2 “feels safe and comfortable”. R2 stated the staff are not angry or agitated. Based on R1’s Needs and Services Plan dated 2/29/2024, R1 is dependent in all activities of daily living and one of the objectives for staff to reassure R1 that caregivers are there to help and assist R1 and staff are always there to listen and assist R1 if there is a problem. Based on R1’s Physician’s Report dated 6/19/2023, R1 does not have auditory impairment. On 3/19/2024, the Department interviewed R1’s primary care physician (PCP). PCP stated R1 is hard of hearing and that may be the reason why the staff will raise their voice. PCP does not believe the staff have malicious intent. The Department has completed the investigation of the above allegation. Based on interviews conducted and record reviews, the Department has found that the above allegation were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Licensee, Felina Roque and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 31, 2024 · control 26-AS-20240301084844

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an case management visit to address information obtained during today's complaint investigation visit. LPA Rai met with Back-Up Administrator/Lead Staff, Lerma Espiritu and stated the purpose of the visit. During today's visit, LPA interviewed staff (S2). S2 was not associated to the facility as of 3/5/2024. Upon further investigation, S2 has a California criminal record clearance and is associated to another licensed facilty but is not associated to this facility. Per interview with S2, S2 did work with the facilty before and left around 2020, but came back to work with the residents as a caregiver in June/July 2023. S2 did confirm to work at the facility January 2024 - March 2024. Back-Up Administrator/Lead Staff and LPA Rai reviewed S2's staff file and did observe LIC 9182 Criminal Background Clearance Transfer Request made in 2019 to transfer S2's criminal record clearance to the facility. Per Guardian, S2 was separated from the facility in 2020. Back-Up Administrator/Lead Staff stated the facility did not transfer S2's criminal record clearance when S2 returned to work at the facility in 2023. Back-Up Administrator/Lead Staff, Lerma Espiritu stated the facility will transfer S2's criminal record clearance to the facility tonight 3/6/2024. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500), for staff (S2) working at the facility without a Criminal Background clearance transfer. Please see LIC 421BG. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. This report was reviewed with Back-Up Administrator/Lead Staff, Lerma Espiritu. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 6, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Mar 7, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ...shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is met as evidenced by: Based on interview and record review, staff (S2) has obtain a California clearance but criminal record clearance has not been transferred to this facility, which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 6, 2024

Plan of correction: Administrator stated to submit a written plan of action understanding regulation and will ensure S2 is associated to the facility by POC due date. Administrator agreed and understood.