Angel Comfort Care 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit for the purpose of completing the required annual visit. Upon arrival, LPA was greeted by Staff (S1) Ricky Edora, who granted entry into the facility. S1 contacted Administrator (AD) Angelina Teves by phone, and LPA spoke with AD to explain the purpose and scope of the visit. LPA toured the interior and exterior of the facility. The facility is a one-story home with five resident bedrooms, three bathrooms, a living room, kitchen, a staff bedroom, and an attached two-car garage.During the tour, LPA observed each resident bedroom contained the required furnishings, including appropriate bed linens, adequate closet and drawer space, and sufficient room to accommodate each resident comfortably. Toilets and water faucets were observed to be operational. Grab bars were observed to be secure, and shower areas were observed to be clean and free of mold or mildew. Hot water temperatures were tested in all three restrooms and measured between 111.2 and 112.3 degrees Fahrenheit.LPA observed smoke detectors and carbon monoxide detectors installed in common areas, hallways, and bedrooms, and each device was tested and found to be operational. LPA observed a fire extinguisher that was fully charged and maintained with a service tag reflecting the last inspection date of February 16, 2025. LPA also reviewed the facility’s fire drill documentation and confirmed fire drills are conducted as required, with records maintained and available for review. Based on observations, and record review, no deficiencies were identified per title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to Caregiver, Ricky Edorathe state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Samer Haddadin made an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted by Staff (S1) Ricky Edora and granted entry into the facility. S1 contacted administrator (AD), Angelina Teves, via phone and LPA spoke with AD and explained the nature of the visit. AD joined the visit at 8:33 AM. Prior to the start of the tour, LPA observed a small plastic cup that had 4 prescription pills on the dining table and in plain view. LPA also observed one ambulatory resident sitting at the same table. I asked the caregiver if the medication belonged to the resident sitting at the table, he said no and that it had belonged to a different resident and forgotten it on the table for unknown period of time. Medication was removed and given to the resident it belonged to. LPA toured the interior and exterior of the facility and observed the following: The facility is a one-story home with five resident bedrooms, three bathrooms, living room, kitchen, staff bedroom, and an attached two car garage. LPA observed Residents’ bedrooms had the required furniture, bed linens and closet/drawer as well as space to accommodate each resident comfortably. LPA observed a camera for each resident’s room placed facing the resident’s bed. AD did not have permission from the resident and was advised that this was a violation of personal rights . AD removed all cameras from all resident’s bedrooms. Toilets and water faucets were observed to be operational, grab bars were secure, and shower was free of mold/mildew. Water temperature was tested in all three restrooms and measured between 111.2 and 112.3 Degree Fahrenheit. LPAs observed smoke detectors/carbon monoxide in common areas, hallways, and bedrooms; all were tested operational. Fire extinguisher was fully charged with service tag indicating last inspection date was on February 16th, 2024. However, Fire drills are not being conducted quarterly; nor did AD have any record of last drill. LPA checked the kitchen area, and all appliances were tested operational. LPA observed sharps and knives where locked and secured, however, (***CONTINUE 809C**) LPA checked under the kitchen sink and observed chemicals and cleaning supplies to be unsecured due to a broken lock. LPA advised AD of the issue and all chemicals and cleaning supplies were later secured in a locked cabinet located in the garage. LPA also observed a broken lock for a cabinet located in the garage that has cleaning supplies. LPA observed AD placing all chemicals and cleaning solution in another secured cabinet LPAs toured the exterior of the facility and observed there was a shaded seating area and ample space for activities; all outside emergency exists were free of tripping hazards and or obstructions or barriers. Facility had inground pool and that is fully fenced with a gate that swings away from pool and is self-latching. LPA observed 3 gallons of paint on the east side of the building alongside of 32oz lighter fluid container that did not have a cap on nor secured. The container was full. LPA observed the facility does not have 7-day supply of non-perishable foods nor any emergency water. LPA checked First aid kit and observed it had all the required elements including bandages, tweezers, thermometer, and scissors however, it did not have manual. LPA reviewed 5 residents’ files and observed all files had all required documentation. LPA reviewed all resident's medication and observed that AD does not keep any daily record of the medication prescribed by physician. Last recorded date on medication was November 21, 2024. LPA asked AD how medication is being administered, AD advised that the person who is in charge of medication had taken the day off and usually pre-fills all resident's medication using containers to help caregiver administer meds Current caregivers. LPA asked caregivers if they had any training in regards of Meds, they both said no. LPA could not verify any medical records for any of the five residents in care. LPAs also reviewed 2 staff files and observed that none of the current staff had any training in dementia care nor any documented training per regulation Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to AD at end of inspection.the state’s words, verbatim · CDSS document, Jan 24, 2025

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility at 10:00 am for the purpose of conducting a Case Management Health and Safety Check. LPA was greeted and granted entry by Caregiver Marilyn Bustamante. LPA asked the Caregiver to call the Administrator to notify them that Licensing is at the facility. Caregiver called Administrator at 10:06 am. LPA toured the facility. Based on review of the fire extinguisher service tags, LPA determined extinguishers have not been serviced since 12/08/2022. A deficiency is being issued on this day. AD Angelina Teves arrived at the facility at approximately 10:30 am. LPA stated the purpose of the inspection. LPA requested and received copies of the following documents: Facility's Relocation Plan as stated on their Disaster Plan, a receipt for most recent payment to utility company and Register of Facility Residents. LPA verified via phone call to the utility company that the facility has a balance of $0.00. LPA verified the facility phone number listed in the FAS profile is accurate. LPA documented the facility updated facility Mobile Number on an LIC812. Based on today's inspection, one deficiency is being cited per Community Care Regulations. This report was reviewed with the Administrator and a copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 16, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80020(a) · Plan of correction due date: Feb 17, 2024

FIRE CLEARANCE: (a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department. This requirement was not met as evidenced by: Based on observation, the Administrator did not ensure the facility’s Fire Extinguisher was serviced annually, (last serviced on 12/8/2022), which poses an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Feb 16, 2024

Plan of correction: Administrator reach out to have the Fire Extinguishers serviced or purchase new Fire Extinguishers and submit proof to LPA via email by POC due date of 2/17/2024.