Angel Comfort Care 3

Type of visit: Required - 1 Year

On May 16, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Angelina Teves was present to assist with the facility inspection on today's date. The facility is licensed for capacity of six residents over age of 60 approved for four (4) non-ambulatory, one (1) bedridden and one (1) ambulatory residents. Facility has approved hospice waiver for four (4) residents. Currently, there is one (1) Hospice resident present during today’s visit. This is a two story with a attached two-car garage facility. The facility has four resident bedrooms (two private rooms and two shared) and two bathrooms. Second story is for staff and inaccessible to residents. At around 8:15AM, LPA Tirre conducted a tour of the physical plant accompanied by Administrator Angelina Teves, and the following was observed: There is a swimming pool fenced and inaccessible to residents on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 109.5 to 116.6 degrees F. A comfortable temperature of 73 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has supply of emergency food and water. Facility has one fire extinguisher which were mounted and fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters such as see something say something, Personal Rights, Emergency Disaster Plan, and Theft & Loss policy were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on May 15, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 3/22/2025 – 3/22/2026. A review of four residents (R1-R4) service files and two staff (S1-S2) personnel files revealed to be complete. LPA verified on active Administrators Certification list that the facility has the current administrator's certification on file for Angelina Teves # 7023029740 - Expiration 8/26/2026. No deficiencies during this inspection visit. An exit interview was conducted with Administrator Angelina Teves, and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 16, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Administrator (AD) Angelina Teves and Kian Pascual. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on April 11, 2024 for a total capacity of six; four non ambulatory, one bedridden and one ambulatory. The facility is approved for four residents on hospice. The facility is a two story home with four client bedrooms, two bathrooms, a dining room, a kitchen, a living area, and an attached two car garage. The upstairs is inaccessible to residents and is for live-in care staff. All exiting doors had alarm notifications. There is a backyard exit gate on the side of the house that is unlocked but does not self-latch. There is a swimming pool that is fenced and inaccessible. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. LPA observed the See Something, Say Something poster (PUB 475), Personal Rights, Visiting Hours and Emergency Disaster Plan in the facility mounted on the wall in the kitchen area. Client bedrooms had the required furnishings. LPA observed all beds had linens and blankets but did not observe night lights in hallways to common bathrooms. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink. Medications will be stored in a locked cabinet. The first aid kit is stored in the garage and has all the required elements. Reading materials and games were observed in the living room with a phone for client use. A supply of seven day of non-perishable food was observed and will be maintained on hand. AD will provide two day perishables upon receipt of residents in care. Smoke detectors and carbon monoxide detectors tested operational. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. AD waived the Component Three Orientation since she has two other licensed facilities. AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report and Technical Advisory was provided to Licensee.the state’s words, verbatim · CDSS document, May 15, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Angelina Teves - CEO/Administrator Interview Method: Telephone interview On April 17, 2024, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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 the 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, Apr 17, 2024