Angel Haven

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with exit doors--a staff room with 4 beds, 3 bathrooms, kitchen and living/dining room. There is a fenced and level backyard, and a detached storage shed. Washer and dryer are located in garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Food supplies are maintained. A comfortable temperature is maintained, and hot water temperature tested at 116 degrees in rear bathroom. At least 2 of 3 toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 5 residents present and 3 staff. One resident is receiving hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including required staff records and training. Client and staff files are reviewed. Ferlene Giusto is a RCFE administrator (x 7/27) that oversees facility operations. The following information/forms are provided today: - Personnel Report (LIC500) - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes--2 pages. ****Due to printer malfunction, report could not be printed and will be emailed to Ms. Giusto***the state’s words, verbatim · CDSS document, Jan 15, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jan 22, 2026

POSTURAL SUPPORTS Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met, as there are 2 half bed rails on bed for client #5, but full bed rails are not included in hospice care plan. Licensee failed to ensure that hospice care plan includes full bed rails for client #5, which poses a potential health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Full bed rails will be included in hospice care plan for client #5, and copy will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.696 · Plan of correction due date: Jan 22, 2026

All RCFEs shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care...shall include 4 hours of training on the care, supervision, and special needs of those residents... 4 hours of training thereafter...per year.... This requirement is not met, as there is no evidence that staff received training on postural supports and restricted health conditions, which poses a potential health, safety or personal rights risk.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Proof that staff received at least 3 hours of training on postural supports and restricted health conditions will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69 · Plan of correction due date: Jan 22, 2026

HEALTH & SAFETY CODE Each employee who received training and passed the exam required... and who continues to assist with the self-administration of medicines, shall also complete 8 hours of in-service training on medication-related issues in each succeeding 12 month period. This requirement is not met, as there is no evidence that staff received 8 hours of medication training in 2025. Records show that staff received 6 hours of med training in 2025. Licensee failed to ensure that staff received required 8 hours of med training.the state’s words, verbatim · CDSS document, Jan 15, 2026

Plan of correction: Staff will receive additional 2 hours of annual medications training, and proof of training will be sent to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this 1-level home, consisting of 6 client bedrooms--all with exit doors--a staff room with 4 beds, 3 bathrooms, kitchen and living/dining room. There is a fenced and level backyard, and a detached storage shed. Washer and dryer are located in garage. No accessible bodies of water or fire safety hazards observed. PPE supply is inspected. Food supplies are maintained. A comfortable temperature is maintained, and hot water temperature tested at 110 degrees in bathroom near staff room. At least 2 of 3 toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. First-aid kit is inspected and complete. A Disaster and Mass Casualty Plan is posted. There are 6 residents present and 3 staff. Three residents receive hospice services. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, including required staff records and training. Six client files are reviewed, including Centrally Stored Medications REcord for one client. Francheska Mendoza is a RCFE administrator (x 11/25) that oversees facility operations. The following information/forms are provided today: - Personnel Report (LIC500) - Proof of current liability insurance - Designation of Administrative Responsibility (LIC308) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. See also Technical Advisory Notes--2 pages.the state’s words, verbatim · CDSS document, Jan 16, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jan 16, 2025

STORAGE SPACE The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage. This requirement was not met, as Comet cleansers are stored in cabinets in 2 bathrooms used by clients. Licensee failed to ensure that cleaning products are stored in secure area, inaccessible to clients. This poses an immediate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Bathroom cabinets were locked in LPA's presence. Deficiency corrected and cleared

From the deficiency page — Deficiency type: Type A · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Jan 17, 2025

POSTURAL SUPPORTS Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met, as client #4 has full bed rails, but there is no hospice care plan on file. Licensee failed to ensure that hospice client has hospice care plan that includes full bed rails, which poses an immedicate health, safety or personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Plan/proof of correction to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a)(3)(B) · Plan of correction due date: Jan 30, 2025

PERSONAL ACCOMMODATION SVCS The licensee shall ensure provision of bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. This requirement was not met, as there are no night stands or reading lamps in at least 4 out of 6 rooms, which poses a potential health, safety, or personal rights risk to clients in care. Licensee failed to ensure that all residents are provided with required furnishings. No nightstands and reading lights in rooms of C1, C2, C3, C6the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Nightstands and reading lights will be installed in all clients' rooms. Proof of correction to be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(4) · Plan of correction due date: Jan 30, 2025

INCIDENTAL MEDICAL CARE No persons other than the dispensing pharmacist shall alter a prescription label. This requirement was not met, as start dates are written on Rx labels by staff. Licensee failed to ensure that no one alters Rx labels, which poses a potential health, safety, or personal rights risk.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Staff will immediately stop writing on Rx labels. Proof/plan of ocrrection to be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458((c)(1)(A) · Plan of correction due date: Jan 30, 2025

MEDICAL ASSESSMENTS The medical assessment shall include...a physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for... communicable tuberculosis. This requirement is not met, as TB test results are not maintained for 3 out of 6 residents. Licensee failed to ensure that all clients have TB test results on file, which poses a potential health, safety or personal rights risk to clients in care. Clients #1, #2, #6 do not have TB test results on file.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: TB test results for C1, C2, C6 will be sent to CCLD BY DUE DATE

From the deficiency page — Deficiency type: Type B · Section cited: CCR87507(g)(3)(A) · Plan of correction due date: Jan 30, 2025

ADMISSION AGREEMENTS Admission agreements shall specify... payment provisions, including...rate for all basic services which the facility is required to provide. This requirement is not met, as admission agreements for 2 out of 6 clients do not include monthly rate. Licensee failed to ensure that basic rate is included in signed admission agreements, which poses a potential health, safety or personal rights risk to clients. Monthly rate missing for clients #3 and #6.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Monthly rates will be added to admission agreements for clients #3 and #6. Copies of admission agreements with monthly rates initialled by responsible parties will be sent to CCLD BY DUE DATE.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(b)(1-7) · Plan of correction due date: Jan 30, 2025

HOSPICE CARE A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include specific information. This requirement was not met, as there are no hospice care plans maintained for 2 out of 3 hospice residents. Licensee failed to ensure that hospice care plans are maintained for all those receiving hospice care. This poses a potential health, safety or personal rights risk to clients in care. No hospice care plans for clients #4 and #6.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: HOspice care plans for clients #4 and #6 will be sent to CCLD BY DUE DATE.

Type of visit: Required - 1 Year

On February 2, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Ferlene Guisto and explained the purpose of the visit. LPA toured facility and grounds. The indoor and outdoor passageways were free of obstruction. No accessible bodies of water of fire safety hazards observed. This is a single story facility with 6 resident private bedrooms, 1 staff room, and 3 bathrooms. LPA observed resident bedrooms with all required furniture. Door alarms from each resident room to the outside passageway was observed to be in good working condition. Bathrooms were observed to be clean and in good repair; equipped with non-skid mats, toilet paper and liquid soap. Kitchen was observed, 2 day perishable and 7 day non-perishable was present. Toxins, sharps, and medication were locked and stored appropriately and inaccessible to residents. Living room and dining room was observed to be clear and free from tripping hazards. A comfortable temperature is maintained at 71 degrees F and lighting is sufficient for comfort. Extra linen was present and first aid kit was observed to be completed. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of June 2023. Emergency drills are logged and done every three months. LPA reviewed 5 resident records and 5 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during this visit. Report is reviewed with Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Feb 2, 2024