Angel Wings Care Home I

Type of visit: Case Management - Other

On 02/07/25 at 2PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit for facility closure. LPA explained the purpose of the visit with administrator (ADM). At 2:10PM, LPA toured the facility with ADM and observed 3 residents living at the facility. ADM stated that there was a change of ownership that occurred on 05/24/24. A new RCFE facility Esther Angels Care Home 079201340 is now operating the facility. During visit, ADM surrendered their state license to LPA. ADM stated that they decided to close the facility because they wanted to have more time with family. Exit interview conducted and a copy of this report provided. Attached is facility closure email sent by administrator on 02/07/25:the state’s words, verbatim · CDSS document, Feb 7, 2025

Type of visit: Required - 1 Year

On 02/06/25 at 12PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1) and explained the purpose of the visit. LPA spoke with ADM on the phone who authorized S1 to act on her behalf and sign the reports. LPA observed ADM has a current administrator certificate# 6056379740 which expires 09/26/2027. At 12:30PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 68 deg F. Hot water temperature was measured at 112 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Smoke and Carbon monoxide detectors were operational. LPA reviewed 3 resident files. LPA did not have access to staff files because caregiver did not have the key to open the staff files cabinet. Continued on next page, LIC 809-C The following deficiencies were observed during visit: Outside pathway leading to side gate obstructed by old mattress left leaning against facility side wall. Disorganized and incomplete resident files - missing appraisal reports Inaccessible staff files - staff does not have the key to open cabinet where staff files are kept Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Required - 1 Year

On 02/29/24 at 1:20PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S2) and spoke with administrator (ADM) on the phone who authorized S2 to act on her behalf and sign the reports. LPA explained the purpose of the visit with S2 and ADM. LPA observed ADM has a current administrator certificate# 6056379735 which expires 09/26/2024. At 1:50PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 70 deg F. Hot water temperature was measured at 115 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 2 staff and 4 resident files. LPA also conducted 2 staff and 2 resident interviews during visit. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Residents Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiency observed during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 29, 2024