Angel Care IV

Type of visit: Required - 1 Year

On January 8, 2026 Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Joy Black. LPA explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory elderly adults ages 60 and above. The facility is approved for six (6) hospice waiver. Currently, the facility has one (1) hospice resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (6) resident' rooms, three (3) bathrooms, a living area, a dining area, a kitchen, an activity room, and an outside patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A water temperature of 109.5 and 114.8 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished during the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained adequately. The fire extinguishers were charged, and smoke detectors and carbon monoxide were operable. A review of Medication Records Administration (MAR) and Fire Drills were observed to be maintained in order and accurate. The facility conducted Fire/Safety Drill on 12/14/25. The facility has a working landline telephone. The staff had all current CPR/First Aid Training on file. Evaluation Report Continues on LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed staff followed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Posters mandated for inspection control were posted. An audit of residents #1-#4 (R1-R4) service records and staff #1-#6 (S1-S6) personnel records revealed to be complete. The facility has current liability insurance effective with policy# 0100376334-40 effective 065/25 through 06/05/2. The facility is current on CCL annual dues. The facility has a current administrator's certificate for #7020935740 11/25/25 through 11/24/27. No deficiencies cited during this inspection visit. An exit interview conducted with Joy Black and a copy of the report is provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Case Management - Annual Continuation

On 01/16/2025, LPA Regina Cloyd conducted an unannounced annual continuation and met with Administrator Mylene Magpile. First Aid kit was available. Two fire extinguishers, last serviced March 20, 2024 was observed in the kitchen and garage area. Staff tested carbon monoxide detectors and smoke detector located near the kitchen and living room. Both devices were functional. On 01/15/25, five resident records were reviewed and, 4 out of 5 resident records had medical assessments. Two residents’ medication was reviewed. Five out of five staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. LPA reviewed the facility's emergency disaster plan and infection control plan. Deficiencies are being cited based on resident record review. On 01/15/25, LPA did not observe documentation for an annual routine visit or virtual visit for Resident #3 (R3). See LIC809-D. An exit interview was conducted, technical assistance provided, and plans of correction were developed. A copy of this report and appeals was discussed and left with the Administrator Mylene Magpile.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Required - 1 Year

On 01/15/24, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Staff Joy Black. Facility is licensed to serve licensed to serve six (6) non-ambulatory elderly residents ages 60 and above. Facility may accept or retain six (6) residents on hospice. The one-story residential house consists of six (6) resident bedrooms, kitchen, dining area, living room, three (3) residents bathrooms, staff quarter (located in the back of the house), garage, washer/dryer located in garage, and backyard with a shaded patio, front landscape and yard was well maintained at time of visit. Joy accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards, doorways were free of obstructions. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured at 113F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Continue to LIC809-C. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. Five resident records were reviewed. Due to insufficient time, an annual continuation is required. An exit interview was conducted and a copy of this report was discussed and left with the Assistant Administrator Joy Blackthe state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: Annual/Random

On 01/08/2024 at 8:23 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with staff Joy Black. Licensee Mylene Magpile joined us 45 minutes later. Six (6) residents and three (3) staff were present during this inspection. Facility is licensed to serve licensed to serve six (6) non-ambulatory elderly residents ages 60 and above. Facility may accept or retain six (6) residents on hospice. The one-story residential house consists of six (6) resident bedrooms, kitchen, dining area, living room, three (3) residents bathrooms, staff quarter (located in the back of the house), garage, washer/dryer located in garage, and backyard with a shaded patio, front landscape and yard was well maintained at time of visit. Joy accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured at 113F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. Two fire extinguishers, last serviced March 20, 2023 was observed in the kitchen and garage area. Staff tested carbon monoxide detectors and smoke detector located in the living room. Both devices were functional. Continue to LIC-809C 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. Two staff interviews were conducted. 5 resident records were reviewed and, 5 out of 5 client records had medical assessments and Needs and Services Plans. Two residents’ medication was reviewed. No deficiencies are being cited. An exit interview was conducted and technical assistance provided. A copy of this report was discussed and left with the Licensee.the state’s words, verbatim · CDSS document, Jan 8, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.