Angela's Care Home

Type of visit: Case Management - Deficiencies

On July 24, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and Safety visit, and met with Administrator, Dulce Redford. During the visit LPA toured the facility along with the Administrator, Dulce Redford, and made observations. There were Health and Safety challenges observed at this time. There will be a Plan of Correction (POC), and citation of 80088 (d). LPA conducted a review of the records to include resident file for Resident # 1(R1), who no longer resides at the facility at the time of this visit. The administrator has followed up with the corrections for the POC for the missing, exterior screen window, at the time of this visit, and the POC will be cleared today 07/24/2026. LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care, with an automated delivery rotation. Based on the information obtained during today's visit, from interviews, record reviews, and the LPA’s observations, there were immediate threats to the health, safety, and welfare of the residents in care. Licensee completed and removed the threats by replacing the window screen. The POC was completed and cleared at the time of the visit. There were deficiencies observed and cited during today's visit, and cleared. An exit interview was conducted, and a copy of this report was provided to the Administrator, Dulce Redford.the state’s words, verbatim · CDSS document, Jul 24, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80088(d) · Plan of correction due date: Jul 31, 2026

Based on LPA Venus Mixson's observations and interviews, the licensee did not comply with the section cited above in the exterior window screen is lose and/or missing, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2026

Plan of correction: REPLACE WINDOW SCREENS Licensee will repair window and screen and email a photograph to LPA by POC due date.

Type of visit: Case Management - Deficiencies

On May 4, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived at the facility unannounced to conduct a Case Management - Deficiencies inspection. LPA met with House Manager (HM), Carina Ripotola, explained the purpose of the visit, and inspected the facility. LPA told HM that a deficiency is being issued to the Licensee, Dulce Redford, due to LPA observing unsigned Admission Agreement for former residents. LPA had observed the missing required signatures during a complaint investigation with complaint number 18-AS-20260330232347. Due to privacy laws, the names of those residents will not be displayed on this report. According to California Code of Regulations, Title 22, Division 6, Chapter 8, Article 9, Section 87507(c), the Licensee is required to have their residents or their responsible parties sign and date the Admission Agreements. As such, a citation is being issued due to the Licensee, Dulce Redford, not obtaining the required signatures in all of their Admission Agreements. Please refer to LIC 809-D for the citation details. A copy of this report, LIC 809-D, and appeal rights, were discussed with and provided to House Manager, Carina Ripotola, whose signature on this form confirms receipt.the state’s words, verbatim · CDSS document, May 4, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(c) · Plan of correction due date: May 29, 2026

87507(c) Admission Agreements; Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any [...] no later than seven days following admission... This requirement is not met as evidenced by: Licensee, Dulce, Redford, did not ensure all Admission Agreements had the required signatures within seven days of client admittance.the state’s words, verbatim · CDSS document, May 4, 2026

Plan of correction: Licensee, Dulce Redford, will review the cited section and obtain the required signatures for all current and all future Admission Agreements. Licensee will submit proof via e-mail to Licensing Program Analyst, Jarred Torres. Proof will be a signed training record and scans or photos of all signed agreements.

Type of visit: Case Management - Deficiencies

On April 21, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived at the facility unannounced to conduct a Case Management - Deficiencies inspection in conjunction with a complaint investigation. LPA met with House Manager (HM), Carina Ripotola, explained the purpose of the visit, and conducted an inspection of the facility. During the inspection of the facility, LPA observed the facility's water service to be shut off. LPA interviewed HM to obtain additional information. HM stated that the Administrator (AR), Dulce Redford, forgot to pay the water bill. HM stated that water service was shut off on April 21, 2026, and that AR made a payment to restore service on the same day. HM stated that the facility has enough drinking water for the two clients in care, the clients in care do not use the shower due to receiving bed baths, and LPA observed single-use disposable dishes and utensils in sufficient quantity for the two clients in care. LPA listened to a recorded phone call between AR and an Eastern Municipal Water District employee who confirmed the water service would be restored on April 21, 2026, which is the same day as this visit. LPA reviewed the facility's LIC 610E, Emergency and Disaster Plan, and had determined that the facility can be self-reliant for seventy-two hours. A deficiency will be cited for California Code of Regulations section 87303(e)(2) because the LPA observed the taps in the facility to not have running water, thus the facility inherently did not have hot water available, at the time of this inspection, as specified in this section. This report, a copy of the deficiency, and appeal rights were provided to and discussed with HM, whose signature on this form confirms receipt. Please see LIC 809-D for the citation related to the deficiencies observed during this inspection.the state’s words, verbatim · CDSS document, Apr 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Apr 22, 2026

California Code of Regulations, 87303(e)(2), Maintenand and Operation: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water... This requirement is not met as evidenced by: The Administrator, Dulce Reford, did not ensure that hot water was readily available for the clients in care. The facility's water was shut off due to non-payment.the state’s words, verbatim · CDSS document, Apr 21, 2026

Plan of correction: Administrator, Dulce Redford, made a payment to Eastern Municipal Water District on April 21, 2026, and provided a printed copy of the receipt. This proof will be received before the end of April 22, 2026.

Type of visit: Required - 1 Year

On March 5, 2026, Licensing Program Analyst (LPA), Jarred Torres, arrived at the facility unannounced to conduct an annual inspection and met with Manager, Carina Ripotola. A facility file review was conducted at the regional office and additional records were requested and reviewed at the facility. Their files were stored and maintained in a secure area. The facility is licensed for six adults and was operating at a capacity of five adults. LPA Torres toured the facility along with Carina and made observations pertaining to the annual inspection. The LPA inspected the facility inside and outside. There were no obstructions on the indoor and outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The single-story home was located at 13247 Sunbird Drive, Moreno Valley, CA 92553. During the tour of the premises, the LPA observed the facility phone to be operable. The facility's phone number is 951-208-1306. The LPA observed the residents' bedrooms which were equipped with the required furniture as stated in Tittle 22 of the California Code of Regulations (CCR). The facility's appliances were observed to be operational at the time of this visit. The facility is equipped with operational smoke detectors and a carbon monoxide detector. The fire extinguisher was in good condition and was serviced on 10/21/25. Required postings regarding safety, personal rights, and emergency exits were posted in the home. The cleaning supplies and sharp items were kept locked and inaccessible to residents in care. Continued on LIC 809-C... The furniture in the facility was in good condition. The facility's cooling and heating system is operational and the air temperature was at 70 degrees Fahrenheit(F) and the hot water was measured at 112 degrees F. The LPA observed the medications to be locked and inaccessible to clients in care. The medication supply was sufficient for the five clients in care. There were no discrepancies with the centrally stored medications and Medication Administration Records. In the kitchen, the food supply of non-perishable and perishable foods consisted of, but not limited to, bread, frozen meats, vegetables, juice, water, and fruits. The facility goes grocery shopping one to two times per week and maintains an appropriate food supply for the five clients in care. Adequate staff was present for the supervision of the residents in care. The facility has a designated area for storing activity supplies and activities are conducted in the living room. Floor plans, telephone numbers and personal rights were displayed in the facility. Administrator, Dulce Redford, had a valid administrator's certificate on file, which expires on 10/3/2027. Client files and staff files were reviewed. Three staff files were reviewed and one did not contain a tuberculosis test. This was discussed with Carina and a plan of correction was developed. During the LPA's review of client files, the LPA observed that three of three reviewed files did not contain a signed copy of the clients' personal rights. This was discussed with Carina and a plan of correction was developed. The LPA reviewed the emergency disaster plan and fire clearance. The emergency disaster plan meets the department's standards, and the next emergency drill is scheduled for March 25, 2026. The LPA inspected the bathrooms and observed the hand washing stations to have the required non-medicated soaps and single-use hand towels. Furthermore, the bathrooms are free of dust and debris. Additionally, the facility has an approved infection control plan in their files. Before leaving the facility, the LPA provided the manager with various LIC forms to help keep their staff and client files organized. An exit interview was conducted and this report was reviewed with the manager, Carina Ripotola. A copy of this report, deficiencies, and appeal rights were provided to the manager, whose signature confirms receipt.the state’s words, verbatim · CDSS document, Mar 5, 2026

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit in order to conduct a case management visit. LPA initially met with Staff, and then later met with Administrator Dulce Redford, who were informed of the purpose of the visit. LPA conducted a walk through, interviews and records review. LPA conducted the visit to get an update on the application of change of ownership with Dulce Redford who confirmed she submitted the additional documents requested by the due date provided by the Department. LPA spoke to Redford and Licensee Angela Zhang who confirmed she is still the licensee and overseeing the facility until Redford receives her license. Licensee stated they still have control of the property and agreed to send an update lease agreement to the LPA. LPA also checked all staff present for fingerprint clearance during the visit and found the (2) staff present are not fingerprinted. Staff #1 (S1) and Staff #2 (S2) were the only staff present with the (3) residents during the time of the visit. The facility was cited for S1 and S2. LPA ensured staff was escorted off the premises. LPA ensured a cleared staff member stayed with the (3) facility residents. Staff stated they had been working at the facility since 09/13/2025, therefore the facility is being cited $100 per day from 09/13/2025 per staff member. An exit interview was conducted with Redford where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 17, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance... This requirement was not met as evidenced by: Based on interview, record review and observation LPA found (2) uncleared staff working at the facility who stated they had been working since 09/13/2025. This poses an immediate health, saftey, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 16, 2025

Plan of correction: During the visit LPA witnessed the removal of S1 and S2, and had the Administrator submit an LIC500 showing staff coverage in S1 and S2's absence. LIC500 shall show coverage that meets resident's needs by cleared staff by the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Anaylts (LPA) Janira Arreola conducted an unannounced visit to the facility LPA initally met with a caregiver Staff, Susan Ouithuyse and spoke with licensee Angela Zhang over the phone who were informed of the purpose of the visit. LPA met with Staff #1 (S1) upon arrival to the facility. S1 expressed they had just started working at the facility today and were the only staff present at the facility. Additionally on 06/26/2025 the licensee e-mailed the LPA copies of the new administrator Staff #2 (S2), and the new facility manager Staff #3 (S3)'s identification cards. LPA reviewed the Guardian roster of fingerprinted and associated staff and found S1, S2 and S3 have fingerprint clearance but are not associated to the facility. During the time of the visit, S2 the new administrator provided the transfer sheet LIC9182 form for S1. Interview with S2 revealed S2 and S3 have been working at the facility since 06/29/2025. Therefore the facility is being cited for S2 and S3 not being associated to the facility. A civil penalty in the amount of $100 per day for the maximum of (5) days is being issued. LPA observed (2) residents at the time of the visit. (1) resident is currently bedridden and the facility does not have a bedridden fire clearance. Therefore, the facility is being cited for fire clearance. This violation warrants an immediate $500 civil penalty. (3) residents observed during visit on 06/11/2025 were observed to no longer be residing at the facility. LPA was informed that Resident #1 (R1) passed away around (1) month ago. The licensee could not recall if they submitted an incident report for R1. A review of incident reports submitted to the regional office and revealed none for R1. Therefore, the facility was cited for not following reporting requirements for resident deaths within (7) days. LPA conducted interview with (1) confidential witness who revealed that they were informed the facility had changed ownership. LPA conducted interview with (3) staff which revealed conflicting information. Upon arrival to the facility LPA was informed by (1) staff that the new facility owner is S2. LPA called the licensee and S2 who informed S2 is managing the facility as the new administrator, however the licensee stated they are still involved in over seeing the facility. The licensee and S2 both confirmed that S2 is now leasing the property and that S2 will be applying for a change in ownership application. A copy of the current lease agreement was reviewed and revealed S2 is the leasing the property. The licensee revealed they did not send a notification of change in ownership to the department and entrusted this task to S2. Therefore, the facility is being cited for lack of reporting the intent to change ownership of the facility. *LPA was off site from 12:20pm to 1:20pm in order to prepare today's report.the state’s words, verbatim · CDSS document, Jul 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Jul 9, 2025

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance...This requirement was not met as evidenced by: Based on interview, records review and observation the licensee did not ensure S2 and S3 were associated to the facility prior to working at the facility. This poses an immediate health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 8, 2025

Plan of correction: The licensee agreed to associate the staff to the facility and submit proof by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR8702(a)(2) · Plan of correction due date: Jul 9, 2025

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the...fire department...Prior to accepting or retaining any of the following types of persons...(2) Bedridden persons This requirement was not met as evidenced by: Based on interview, observation and record review the facility has (1) bedridden resident in care and does not have proof of bedridden clearance. This poses an immediate health saftey or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 8, 2025

Plan of correction: The licensee agreed to follow proper eviction procedures to issue the bedridden resident an eviction notice by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Jul 9, 2025

87211 Reporting Requirements (a) Each licensee shall furnish...such reports...including...(1)A written report...submitted to the licensing agency... within seven days of the occurrence of...(A)Death of any resident from any cause...This requirement was not met as evidenced by: Based on interview observation and record review the licensee did not report a resident death in a timely manner. This poses an immediate health saftey or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 8, 2025

Plan of correction: The licensee agree to submit an incident report for the resident by the POC due date. The licensee also agree to obatin outside resource training on incident reporting and submit proof of training by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87109(b)(1-2) · Plan of correction due date: Jul 9, 2025

87109 Transferability of License (b)...the property and business shall not be transferred until the buyer qualifies for a license or provisional license...(1)The seller shall notify, in writing, a prospective buyer of the necessity to obtain a license...if the buyer’s intent is to continue operating the facility...The seller shall send a copy of this written notice to the licensing agency.(2)The prospective buyer shall submit an application for a license...within five days of the acceptance of the offer.. This requirement was not met as evidenced by: Based on interview and record review the property was transferred to S2 and a notification of change in ownership was not provided to the department. This poses an immediate health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 8, 2025

Plan of correction: The licensee agreed to provide S2 with a written notice of the intent to change ownership and the need to apply for a license. This is due by the POC due date. The licensee agreed to ensure S2 submits an application for a new license within (5) days as specified in this chapter and send proof to the LPA.

Allegation investigated: Resident's dietary needs were not met by facility staff. Staff did not safeguard resident's personal belongings.

On 5/18/2025 at approximately 8:00 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met Jin Zizi/Licensee. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#2), Resident’s interviews (R#1-R#6) and Witness 1 Interview. LPA obtained and reviewed the following documents: Resident Roster dated: 4/26/25, Staff Roster dated: 5/9/25, (R#1-R#6) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 3/15/25, 3/17/25, 1/6/25, 2/21/25, 7/30/23, (R#1-R#6) Admissions Agreement dated: 2/16/2023, 5/15/2023, 4/19/2023, 4/20/23, 1/15/23, and 3/18/25, (R#1-R#6) Client/Resident Personal Property and Valuables or LIC 621 dated: dated: 2/16/2023, 5/15/2023, 4/19/2023, 4/20/23, 1/15/23, and 3/18/25, Facility Staff Annual Medication In-service training sheet dated: 2/28/2025, Health and Safety check of facility food supply. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Resident's dietary needs were not met by facility staff. The detail of the complaint alleges that facility does not offer meal substitutes for residents in care. On May 17, 2025, at approximately 1:00 PM, during a records review, LPA Iniguez observed the Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A. The reports were dated March 15, 2025; March 17, 2025; January 6, 2025; February 21, 2025; and July 30, 2023. Among the reviewed records, only (R#2, R#3, and R#5) had a special diet indicated on the form, while (R#1, R#4, and R#6) did not have any special diet noted. On May 17, 2025, at approximately 8:30 AM, during an interview with the Administrator (A#1), she stated that they provide a variety of foods to accommodate residents' dietary needs, including diabetic diets and low-salt diets. Additionally, (A#1) mentioned that there are currently (3) residents in care who require special diets (R#2, R#3 and R#5). On May 17, 2025, at approximately 11:00 AM, during interviews with residents (R#1-R#6), (3) out of (6) stated that they have special diet requirements, and the facility staff has successfully accommodated their needs. In addition, (2) out of (6) residents in care stated they do not have any special diet requirements. On May 17, 2025, at approximately 11:40, LPA Iniguez could not speak with (R#5) due to cognitive impairment. On May 17, 2025, LPA Iniguez contacted (W#1), the spouse of (R#5), three times; however, (W#1) did not return LPA Iniguez's phone call. Evaluation Report continues LIC 9099-C On May 17, 2025, at approximately 10:00 AM, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that they offer different kinds of foods to meet residents' dietary needs, such as diabetic diet, low salt, etc. Also, (2) out of (2) facility staff stated that they only have (3) residents in care with special diets (R#2, R#3 and R#5). Allegation: Staff did not safeguard resident's personal belongings. The detail of the complaint alleges that facility staff is not safeguarding residents’ personal belongings. On May 17, 2025, at approximately 9:00 AM, during a records review, LPA Iniguez observed (R#1-R#6)’s Client/Resident Personal Property and Valuables or LIC 621 dated: dated: 2/16/2023, 5/15/2023, 4/19/2023, 4/20/23, 1/15/23, and 3/18/25. All forms were completed and filed by facility staff. On May 17, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that they try their best to safeguard all residents ' personal belongings. On May 17, 2025, at approximately 11:00 AM, during interviews with residents (R#1-R#6), (5) out of (6) stated that their personal belongings are being kept safe by the facility. In addition, (5) out of (6) residents in care stated that they feel safe living here. On May 17, 2025, at approximately 11:40, LPA Iniguez could not speak with (R#5) due to cognitive impairment. On May 17, 2025, LPA Iniguez contacted (W#1), the spouse of (R#5), three times; however, (W#1) did not return LPA Iniguez's phone call. Evaluation Report continues LIC 9099-C On May 17, 2025, at approximately 10:00 AM, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that the facility safeguard all residents personal belongings. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Jin Zizi/Licensee.the state’s words, verbatim · CDSS document, May 18, 2025 · control 18-AS-20231206090929

Allegation investigated: Staff do not ensure that residents' dietary needs are met. Staff threatened resident. Resident was not accorded privacy.

On May 18, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent visit to gather information regarding the above allegations. LPA met with Ying Zi Zhang, Licensee and Administrator, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3) resident members #1 to #7 (R1-R7) and witness #1 (W1). List of documents reviewed/obtained Register of Faciltiy Residents LIC 9020, Personne Report (dated 05/09/25), (R1-R7)'s Physicians Report LIC 602 (dated 01/05/23, 01/20/23, 06/14/23, 09/01/24, 01/06/25, 02/20/25, 03/17/25, and 03/18/25), Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 3/17/23, and 03/18/23), and other records pertinent to this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #2: Staff do not ensure that residents' dietary needs are met. It is alleged that facility staff did not meet residents’ dietary needs. Reports indicate that staff do not provide snacks to Resident #1 (R1) and that the facility charges for food. Additionally, the food supply comes from food donation banks. No further details regarding this matter were provided. On September 16, 2024, October 04, 2024, and May 17, 2025, between 09:30 AM and 04:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) resident members could not validate this allegation. (R1) refuted this claim and stated it is false. (R2-R6) reported receiving three meals and two snacks daily to cater to their dietary needs. (R2-R6) expressed that food is healthy and of high quality. (R2-R6) confirmed that they are not charged for meals or snacks. (R7) was interviewed but could not converse due to a health condition. On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not corroborate this allegation. (S1-S3) residents are provided three meals and two snacks in between. The snacks and meals are prepared to cater to individual dietary needs and preferences. (S1-S3) reported that grocery inventory supplies are purchased from major grocery retail chains such as Costco, Superior Market, and WinCo. (S1-S3) clarified that residents are not charged for their meals or snacks, as this is part of the basic services. The Department inspected the food supply and noted the presence of various items, including bread, dairy products, eggs, cereal, fruits, and vegetables. Ample nonperishable food supplies were available for at least one week, while perishable items were sufficient for a minimum of two days on the premises following Title 22 regulations. The review of the Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 03/17/23, and 03/18/23) revealed the following on page 8, under the Basic Services subsection Food Services (a)(b): Three (3) nutritious meals are provided daily, and snacks are available between meals. (Evaluation Report continues LIC 9099-C) Special diets, prescribed by a physician, are included as a free service at no charge. An examination of the licensee's bank statements showed a trend of grocery purchases, where inventory supplies were sourced from reputable grocery chains. Based on the information, there is not enough evidence to support the claim mentioned above. Allegation #3: Staff threatened resident. It is alleged that staff threatened Resident #1 (R1). The report details that the staff threatened (R1) with the ability to move out of the facility during an open conversation within the facility. No further details regarding this matter were provided. On September 16, 2024, October 4, 2024, and May 17, 2025, between 9:30 AM and 4:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Five (5) out of the seven (7) resident members could not support the allegation. (R2-R6) reported that they have not experienced any threats from staff members. The residents appreciated the staff, stating they are treated like family. (R1) mentioned in a conversation that the licensee was insinuating (R1) to find a new place to live and (R1) was worried about the possibility of an eviction. However, (R1) noted that the licensee had no history of evicting residents. (R7) was interviewed but could not converse due to a health condition. On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members stated this claim is false. (S1-S3) expressed that residents are treated with utmost respect and dignity and no resident is threatened in writing, verbal, or physically. (S1) clarified in an open conversation overheard (R1) and (R1)’s negative statements about the facility, and (S1) made an inquiry about the situation. (S1) stated that (R1) had misunderstood the conversation and there was never an eviction, even implied or served to (R1). According to (S1), (R1) was not evicted and continued to reside at the facility until November 2024. At that point, (R1) needed a higher level of care and transitioned to a skilled nursing home. On May 09, 2025, between 04:48 PM and 05:07 PM, the Department interviewed the witness member identified as Witness #1 (W1), the family representative for (R1). (W1) confirmed that (R1) was a former Angela's Care Home resident until November 2024 and was transitioned to a skilled nursing home. (Evaluation Report continues LIC 9099-C) (W1) confirmed that (R1) was never threatened with an eviction. (W1) explained that (R1)'s health condition affected (R1)'s state of mind. The Department reviewed (R1)’s Physician Report LIC 602A (dated 09/1/24), which revealed that (R1)’s mental status was diagnosed as confused or disoriented. A further review of staff training topics included Alzheimer’s Disease and related disorders, caring for patients with a change in mental status, activities of daily living (ADLs) and behaviors, challenging behaviors, and Basic Essentials. During the May 16, 2025 visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, the California Residential Care Facilities for the Elderly Complaint Poster, and the California Long Term Ombudsman Poster. This helps residents know their rights and feel good about their living situation. Based on the information, there is not enough evidence to support the claim mentioned above. Allegation #4: Resident was not accorded privacy. It is alleged that Resident #1 (R1) is not accorded privacy. According to reports, (R1) was not granted privacy during a telephone conversation by staff. No further details regarding this matter were provided. On September 16, 2024, October 4, 2024, and May 17, 2025, between 9:30 AM and 4:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Five (5) out of the seven (7) residents could not validate the allegation. (R2-R6) claimed the staff grants them privacy. (R2) mentioned that not all residents have personal cell phones and will use the house phone. The staff granted permission to go anywhere in the facility to conduct their calls and there are no privacy issues. (R1) mentioned having had a telephone conversation in an open space with other residents and staff who were present. (R1) conducted the phone call not in private, and the discussions with the party were overheard. On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members stated this claim is untrue. (S1-S3) expressed that residents are treated with utmost respect, provided their space and privacy. The residents can use their personal space when conducting personal phone calls. (Evaluation Report continues LIC 9099-C) (S1-S2) claimed that one incident with (R1) occurred when (R1) chose to perform the call in an open environment where staff and residents gathered for activities. (R1) had the privilege of making the call privately in (R1)’s room, locking the door for complete privacy, or taking the call in the patio area. On May 09, 2025, between 04:48 PM and 05:07 PM, the Department interviewed the witness member identified as Witness #1 (W1), the family representative for (R1). (W1) confirmed that (R1) was often not in the right mind. (W1) stated that she was pleased with the facility's services. (W1) praised the licensee's operations and stated she had no concerns for (R1)'s care at this facility. The review of (R1-R7) 's Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 03/17/23, and 03/18/23) revealed the following on page 23, under the Resident/Personal Rights, is verified with an acknowledgment signature. A further review of staff training topics included Alzheimer's Disease and related disorders, caring for patients with a change in mental status, activities of daily living (ADLs) and behaviors, challenging behaviors, and Basic Essentials. During the May 16, 2025 visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, the California Residential Care Facilities for the Elderly Complaint Poster, and the California Long Term Ombudsman Poster. This helps residents know their rights and feel good about their living situation. The Department was unable to conduct a follow-up interview with Resident #1 (R1) because the resident passed away on May 4, 2025, while in care at Rancho Bellagio Post Acute. The Department attempted to contact Resident #3 (R6)'s family representative, but none of the calls were returned. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated. Based on the information, there is not enough evidence to support the claim mentioned above. An exit interview conducted with administrator Ying Zi Zhang and copies of the report provided.the state’s words, verbatim · CDSS document, May 18, 2025 · control 18-AS-20240909145521

Allegation investigated: Staff assists residents with medication without proper training. Facility records are not properly maintained. Residents are not provided a variety of foods.

On 5/17/2025 at approximately 8:00 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met Jin Zizi/Licensee. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#2), Resident’s interviews (R#1-R#6) and Witness 1 Interview. LPA obtained and reviewed the following documents: Resident Roster dated: 4/26/25, Staff Roster dated: 5/9/25, (R#1-R#6) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 3/15/25, 3/17/25, 1/6/25, 2/21/25, 7/30/23, (R#1-R#6) Admissions Agreement dated: 2/16/2023, 5/15/2023, 4/19/2023, 4/20/23, 1/15/23, and 3/18/25, (R#1-R#6) Client/Resident Personal Property and Valuables or LIC 621 dated: dated: 2/16/2023, 5/15/2023, 4/19/2023, 4/20/23, 1/15/23, and 3/18/25, Facility Staff Annual Medication In-service training sheet dated: 2/28/2025, Health and Safety check of facility food supply. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff assists residents with medication without proper training The details of the complaint alleged that facility staff does not have the proper training to give medications to the residents in care. On May 17, 2025, at approximately 1:00 PM, during a records review, LPA Iniguez observed that the latest Facility Staff Annual Medication In-service training sheet was done on 2/28/2025. On May 17, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that the person who dispenses medication is herself and (S#2). In addition, (A#1) stated that the facility staff and she were trained in medication management every year. On May 17, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R#6), 5 five out of 6 stated that they take their medications as prescribed by their physician. Also, (5) out of (6) stated that they think the facility staff is trained on how to manage and dispense medication. On May 17, 2025, at approximately 11:40, LPA Iniguez could not speak with (R#5) due to cognitive impairment. On May 17, 2025, LPA Iniguez contacted (W#1), the spouse of (R#5), three times; however, (W#1) did not return LPA Iniguez's phone call. On May 17, 2025, at approximately 11:00 AM, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that (A#1 and S#2) give their prescribed medications to the residents in care. In addition, (2) out of (2) facility staff stated that they received training regarding managing and dispensing medication every year. Evaluation Report continues LIC 9099-C Allegation: Facility records are not properly maintained. The details of the complaint alleged that licensee does not have facility staff records properly maintained. On May 17, 2025, at approximately 2:00 PM, during a physical tour of the facility, LPA Iniguez observed that the resident files were stored inside a file cabinet that can be locked in privacy. In addition, LPA Iniguez observed that the resident’s file was well-organized and properly kept. On May 17, 2025, at approximately 1:00 PM, during a records review, LPA Iniguez observed (R#1-R#6) files well-kept and organized by facility staff. On May 17, 2025, at approximately 8:30 AM, during an interview with the Administrator (A#1), she stated that they kept the records inside a file and locked them at the facility. Also, (A#1) stated that the residents’ records are very organized. On May 17, 2025, at approximately 11:00 AM, during interviews with residents (R#1-R#6), (5) out of (6) stated that they think the facility staff kept their personal files properly. On May 17, 2025, at approximately 11:40, LPA Iniguez could not speak with (R#5) due to cognitive impairment. On May 17, 2025, LPA Iniguez contacted (W#1), the spouse of (R#5), three times; however, (W#1) did not return LPA Iniguez's phone call. Evaluation Report continues LIC 9099-C On May 17, 2025, at approximately 10:00 AM, during interviews with facility staff (S#1-S#2), 2 two out of 2) stated that stated that the residents’ files are being kept locked in a file cabinet. Also, (2) out of (2) facility staff stated that the residents’ records are well-kept and organized. Allegation: Residents are not provided a variety of foods. The details of the complaint alleged that facility does not offer a variety of foods to the residents in care. On May 17, 2025, at approximately 2:00 PM, during a physical tour of the facility's kitchen and pantry, LPA Iniguez observed a variety of food items such as bread, frozen meats, dairy products, eggs, vegetables, cereals, and can products that meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. On May 17, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that the facility offers different kinds of food items, such as meats, vegetables, and carbohydrates, to the residents in care. On May 17, 2025, at approximately 11:00 AM, during interviews with residents (R#1-R#6), (5) out of (6) stated that the facility offers them a variety of food, such as meat, vegetables, and carbohydrates. On May 17, 2025, at approximately 11:40, LPA Iniguez could not speak with (R#5) due to cognitive impairment. On May 17, 2025, LPA Iniguez contacted (W#1), the spouse of (R#5), three times; however, (W#1) did not return LPA Iniguez's phone call. On May 17, 2025, at approximately 10:00 AM, during interviews with facility staff (S#1-S#2), (2) out of (2) stated that the facility offers different kinds of food items, such as meats, vegetables, and carbs, to the residents in care During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Jin Zizi/Licensee.the state’s words, verbatim · CDSS document, May 17, 2025 · control 18-AS-20231206090929

Allegation investigated: Staff do not prevent a resident from wandering at the facility.

On May 17, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent visit to gather information regarding the above allegations. LPA met with Ying Zi Zhang, Licensee and Administrator, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3), resident members #1 to #7 (R1-R7), and witness #1 (W1). List of documents reviewed/obtained Register of Faciltiy Residents LIC 9020, Personne Report (dated 05/09/25), (R1-R7)'s Physicians Report LIC 602 (dated 01/05/23, 01/20/23, 06/14/23, 09/01/24, 01/06/25, 02/20/25, 03/17/25, and 03/18/25), Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 3/17/23, and 03/18/23), and other records pertinent to this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff do not prevent a resident from wandering at the facility. The complaint states that the facility staff prevented a resident from wandering. It is reported that Resident #2 (R2) wandered into Resident #1 (R1) without permission and invaded (R1)’s space and privacy. Further reports indicated that (R2) wandered into the room and went through (R1’s) personal property, tampering with the refrigerator and television. No additional details regarding this matter were provided. On September 16, 2024, October 04, 2024, and May 17, 2025, between 09:30 AM and 04:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) resident members could not validate this allegation. (R1) denied the allegation, asserting that it is false. (R2) rejected the claim and confidently stated that (R2) does not recall interacting with (R1). (R3- R6) asserted that they respect each other’s personal space and prioritize their privacy. (R7) was interviewed but could not converse due to a health condition. On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not support this allegation. (S1-S3) The residents have Major Neurocognitive Disorder (major NCD). Occasionally, individuals may momentarily lose track of their designated room, but they will be quickly and effectively guided to the correct location. This confusion is completely understandable and not intentional. On May 09, 2025, between 04:48 PM and 05:07 PM, the Department interviewed the witness member identified as Witness #1 (W1), the family representative for (R1). (W1) confirmed that (R1) was a former Angela's Care Home resident until September 2024 and was transitioned to a skilled nursing home. (R1) required 24/7 care. (W1) who reported was unable to support this allegation. (W1) stated that the dedicated staff truly prioritized (R1) 's well-being, providing excellent care and attentive supervision without concerns. After reviewing the Physician's Report LIC 602A for (R1-R7) 's (dated 01/05/23, 01/20/23, 06/14/23, 09/01/24, 01/06/25, 02/20/25, 03/17/25, 03/18/25) revealed that (6) out of (7) (R1-R6) all did not have wandering issues. Further review of (R1-R7) 's Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 3/17/23, and 03/18/23) revealed that, listed on page 23, all residents acknowledge Personal Rights. (Evaluation Report continues LIC 9099-C) A review of staff training topics included Alzheimer’s Disease and related disorders, caring for patients with a change in mental status, activities of daily living (ADLs) and behaviors, challenging behaviors, and Basic Essentials. During the visit on May 16, 2025, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, the California Residential Care Facilities for the Elderly Complaint Poster, and the California Long Term Ombudsman Poster. This helps residents know their rights and feel good about their living situation. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. The Department was unable to conduct a follow-up interview with Resident #1 (R1) because the resident passed away on May 4, 2025, while in care at Rancho Bellagio Post Acute. The department made several attempts to contact the family representative for Resident #3 (R3), but none of the calls were returned. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. While the allegation may be valid or have occurred, there is insufficient evidence to establish whether the alleged violation took place or did not. Therefore, the allegation is determined Unsubstantiated. An exit interview was conducted with caregiver Elicia Alvarez, and copies of the report were provided.the state’s words, verbatim · CDSS document, May 17, 2025 · control 18-AS-20240909145521

Type of visit: POC

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility to conduct a Plan of Correction (POC) visit. LPA met with Licensee, Angela Zhang who was informed of the purpose of the visit. LPA conducted interviews, records review, and a walk through of the home. The following POCs were met during or before the time of the visit and cleared during the visit: On 3/20/2025, LPA issued a citation for 87202(a) Fire Clearance for bedridden resident which the facility is not approved for. The POC was for the licensee to submit a request for a bedridden fire clearance by the POC due date of 3/21/2025. On 3/21/2025 the regional office received the application for the fire clearance. LPA checked on the bedridden resident during the visit and observed the resident is located in a room with a second exit door. Therefore, the POC has been met and a clearance letter was provided at the time of the visit. On 2/18/2025 LPA issued citation for 87467(a)(3) Resident Participation in Decision making for (1) resident’s whose care plan was signed by the Licensee twice, once for the licensee and once for the resident’s responsible party. Interview and record review revealed the Licensee is not the resident’s responsible party and the Licensee did not send the care plan to the responsible party for review. POC was for the Licensee to send the care plan to the responsible party by POC due date 2/25/2025, On 2/23/2025 the licensee submitted proof to the LPA of submitting the care plan to the resident’s representative for review and signature. Therefore, the POC has been met and the licensee was issued a clearance letter at the time of the visit. 87412(a) Personnel Records was cited for incomplete and unavailable staff files for licensing to review. 87411(c)(6) Personnel Requirements – General was also cited for lack of documented staff training. The POC was for the Licensee to submit the complete staff files to the LPA and appoint a new administrator to audit the staff files for completion. LPA received an email appointing new administrator Victor Otuya. During the visit, LPA reviewed staff training conducted. Therefore, the POC has been met and the deficiency was cleared. On 3/26/2025 LPA received notification appointing VICTOR OTUYA as the new administrator but did not receive a copy of the completed staff files. The LPA needs to review LIC501, Administrator’s Certificate, first aid and CPR training for the Licensee. 40-hour annual training, LIC501, TB test and physical need to be submitted for Staff #1 (S1) and Staff #2 (S2). S2’s medication training also needs to be submitted. During today’s visit LPA conducted file review and reviewed Licensee's, S1, and S2's file and documents listed above. Therefore, the POC has been met and the deficiency was cleared for staff records. 87412(e) Personnel Records was cited for the licensee not having an LIC500 showing staff coverage. 87705(b)(2) Care of Persons with Dementia was also cited as staff interviews revealed there is no awake staff at night despite residents being diagnosed with Dementia in the home. The POC was for the licensee to submit an LIC500 showing staff coverage at all times, and awake staff at night. The licensee submitted a completed LIC500 to the LPA on 3/24/2025. Therefore, the POC has been met and the deficiency was cleared. The following POC was previously agreed upon and the POC due date has passed: On 2/18/2025 LPA conducted an annual visit and cited deficiencies. The POC due date and date for addressing the POC has passed. Therefore, the deficiency is being recited with new POC due date. The following are the previously cited item: 87470(c)(1)(C) Infection Control Requirements was cited for not having an infection control plan for licensing review. The POC was for the licensee to submit their infection control plan. The Licensee also agreed to send a self certified statement appointing a new administrator that will help audit the facility files and ensure all files are complete at the facility by the POC due date. On 3/26/2025 LPA received notification appointing VICTOR OTUYA as the new administrator but did not submit a self certified statement from the Licensee. LPA has also not received the facility’s infection control plan. On today’s visit LPA spoke with Licensee who showed the LPA the infection control plan they had on file. The plan was not filed out. The licensee stated they could fill out and send to LPA by POC due date. Therefore, the facility still does not have an infection control plan for licensing to review. The deficiencies is being recited and a new POC due date was issued. An exit interview was conducted where a copy of this report, deficiency pages, and clearance letters were reviewed and provided.the state’s words, verbatim · CDSS document, Apr 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(c)(1)(C) · Plan of correction due date: Apr 18, 2025

(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above due to no infection control plan being retained at the facility during the time of the visit which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: The licensee agreed to fill out the courtsey form on file and send the LPA the comcpleted form by the POC due date.

Type of visit: POC

Licensing Program Analysts (LPA)’s Janira Arreola and Seo Jeon, conducted an unannounced visit to the facility to conduct a Plan of Correction (POC) Visit. The purpose of this report is to document the POCs that were previously agreed upon and which the POC due dates have passed. LPAs met with Licensee, Angela Zhang who was informed of the purpose of the visit. LPAs conducted a walk through, conducted interviews, and records review. There were (2) staff and (6) residents present during the visit. During Annual Visit conducted on 02/18/2025 the facility was cited for California Code of Regulations (CCR) Section 87202(a)(2) for Resident #1 (R1) who is bedridden, while the facility is not approved for bedridden residents by the local fire jurisdiction. The POC was to call the fire department, place R1 in a room with a second exit door, and apply for a bedridden clearance and submit by the POC due date of 02/19/2025. On 02/18/2025, LPA observed the licensee called the fire department and alerted them on the bedridden resident. During today's visit LPAs conducted a health and safety check on R1 and observed they are in a room with a second exit door. Interview with the licensee and record review revealed the licensee has not submitted the request for bedridden fire clearance. Therefore, the POC has not been met. The POC is being recited and a new POC due date was issued. An exit interview was conducted with Licensee Angela Zhang where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Mar 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Mar 21, 2025

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons. This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above with R1 who is bedridden. The licensee is not approved for bedridden clearance which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 20, 2025

Plan of correction: The licensee called the fire department during the time of the visit to notify of the bedridden resident, and agreed to submit a request for a bedridden fire clearance. The licensee agreed to move the resident to a room with an emeregency exit leading to the exterior of the home and exit route. Proof to be submitted by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with staff and was later joined by Administrator and Licensee Angela Zhang who were informed of the purpose of the visit. At the time of the visit there was (3) staff and (5) residents present. The facility is a one story home with (4) bedrooms and (2) bathrooms for residents and (1) staff bedroom. No pools or firearms are being kept at the facility. LPA observed the following: Infection Control: The LPA observed the facility restrooms and kitchen had hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA did not have an infection control plan at the time of the visit, there a citation is being issued. Physical Plant: LPA observed the resident bedrooms. Physical plant, floors, windows, and doors were observed and fixtures and furniture were in good were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational. The hot water temperature was initially read at 110F in a resident restroom. Based on record review Resident #2 (R2) is bedridden and the licensee is approved for non-ambulatory residents only. LPA observed R1's room does only has (1) exit and does not have a side door leading to the emergency route. Therefore, the licensee is being cited for not having the appropriate fire clearance. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. Required postings were found in the facility. The current administrator provided proof of their Administrator's Certificate. Based on staff interview it was revealed that only (1) staff and (1) volunteer are working at the facility at this time, and (1) administrative staff comes to supervised the staff's work but does not assist with direct care needs. Staff and Licensee revealed there is no awake staff at night, when assistance is needed residents call on the staff. The licensee was interviewed who stated they do assist residents and are present at the facility every day including at night. However, the licensee did not have a staff schedule at the time of the visit to verify the staff schedules. Therefore, the licensee is being cited for not having an up to date staff schedule reflecting coverage at all times. Record Review and Resident/Staff Files: LPA reviewed (1) staff file and conducted an interview with staff which revealed the training was received from their previous employment. The licensee revealed they would have to document the hours of training provided. The licensee is being cited for not having documentation of staff training. LPA was unable to review (2) of (3) staff files due to them not being available at the time of the visit. Staff 1 (S1) did not have a file at the time of the visit. The licensee is being sited for not having staff file present for review. Resident #3 (R3) did not have a SAFEGUARDS FOR PROPERTY/VALUABLES form in their file. Therefore, the licensee is being cited for not having this document at the time of the visit. Resident #4 (R4)'s Needs and Services Plan revealed the licensee is signing as the R5's legal representative. Interview with licensee revealed they had not sent the form to the responsible party for signature and review. Therefore, the licensee is being cited for not having a meeting with the resident's representative. Health Related Services/ Incidental Medical Services: All resident medications were locked. LPA reviewed resident medication records which revealed medication had required labeling and centrally stored lists for all residents. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The licensee stated they conducted their last fire drill a year ago which did not meet the licensing requirements. Therefore a citation was issued for not having completed a fire drill. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items. An exit interview was conducted where this report was reviewed along with the deficiency pages and appeal rights. *LPA was present at the facility from 9:00am to 11:50am, then returned to the facility from 1:10pm to 3:45pm in order to prepare the report.the state’s words, verbatim · CDSS document, Feb 18, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced Plan of Correction (POC) Visit. LPA met with, Licensee, Angela Zhang, who was informed of the purpose of the visit. The following POC’s were cleared at the time of the visit: On visit date 12/04/2024, deficiency was cited for 87303(e)(2) Maintenance and Operation. Based on observation the water temperature in the facility restrooms read 122F and 125F. This posed a potential health, safety, or personal rights risk to residents in care. The POC was to adjust the water temperature to the required range. The licensee agreed to send proof of the required temperature by the POC due date of 12/13/2024. On the POC due date, LPA received photos of the hot water temperature in the master bathroom reading at 110F. LPA did not receive photos of the common restroom. On today’s visit LPA tested the hot water temperature in both bathrooms which revealed the common restroom sink has a hot water temperature of 116F and the master bathroom shower has a hot water temperature of 105.2F. Therefore, the POC has been met and the POC was cleared at the time of the visit. A clearance letter was provided to the licensee. The following POC’s were not cleared at the time of the visit and Civil Penalties are being assessed: On visit date 12/04/2024, deficiency was cited for 87468.2(a)(1) Additional Personal Rights of Residents in Privately Operated Facilities. Based on interview and observation, the private shower in the master bathroom was being used by all staff and residents due to the common restroom having a faulty shower faucet, This posed a potential personal rights, health, or safety risk to residents in care. The POC was to fix the common shower of the facility and inform the LPA when the repairs are completed in order to provide privacy to residents in the shower and in their private bedroom and ensure the facility is in good repair. The licensee agreed to send proof of the POC by the due date of 12/27/2024. LPA observed the common shower is only delivering cold water due to the repairs not being completed on the faucet. Based on staff and resident interviews, staff and residents are currently using the master bathroom shower only. Therefore, the POC has not been met and was assessed civil penalties for failure to correct. Civil penalties are being assessed from 12/28/2024 to 12/31/2024 at $100 per day. The licensee was advised that civil penalties will continue to accrue until the POC is met. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Dec 31, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility for an unrelated matter. The following report documents deficiencies observed during the visit. LPA met with Licensee, Angela Zhang who was informed of the purpose of the visit. LPA conducted a walk through of the facility, (1) staff and (3) resident interviews which revealed the facility restrooms are not working properly and are in need of repair. LPA observed the common restroom on the hallway of the home, does not have hot water in the shower due to the faucet not moving to the hot setting. The staff stated the residents and staff use the private restroom to shower as the common restroom. LPA also checked the water in the private restroom in the master bedroom and observed that the water was coming out of the sink due a crack in it which spilled all over the bathroom floor. Deficiency was cited and plan of correction was created for licensee to fix the sink and shower. LPA checked the facility hot water in the sinks and found the water was over 120F at 122F in the private restroom and 125F in the common restroom sinks. Deficiency was cited and a plan of correction was created with the licensee. An exit interview was conducted where this report along with deficiencies and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, Dec 4, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Dec 27, 2024

(a) ...shall have...the following personal rights: (1)...reasonable level of personal privacy in accommodations… This requirement was not met as evidenced by: Based on interview and observation, the private shower in the master bathroom is being used by all staff and residents. This poses a potential personal rights, health or saftey risk to residents incare.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: The licensee agreed to fix the common shower of the facility and inform the LPA when the repairs are completed. The licensee agreed to send proof of repiar by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(e)(2) · Plan of correction due date: Dec 13, 2024

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of...not more than 120 degree F (49 degree C). This requirment was not met as evidenced by: Based on observation the water temperature in the facility restrooms read 122F and 125F. This poses a potential health saftey or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: The licensee agreed to adjust the water temperature to the required range. The licensee agreed to send proof of the required temperature b y the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of conducting the annual inspection. LPA Colvin met with staff Higinio Alvarez and informed him of the purpose of today's inspection. Below is a summary of what was observed: Infection Control: LPA Colvin observed that the facility has an updated Infection Control Plan on file and is demonstrating best practices in the facility to maintain a healthy environment for staff and residents. Such measures include: soap and paper towels at hand washing stations and hand washing guides posted. Physical Plant: LPA Colvin toured the facility and observed that there a sufficient bedrooms and bathrooms for both staff and residents. LPA Colvin observed the required furniture and linen to be present and in good condition in resident bedrooms. LPA Colvin measured the hot water in the bathroom faucets to be 100.9 degrees. Deficiency cited. LPA Colvin tested the facility's carbon monoxide alarm and smoke detectors and found them to be operational. LPA Colvin observed that sharp objects like knives were locked away from residents' reach in a drawer in the kitchen. LPA Colvin toured the backyard and confirmed that no exits or pathways were blocked. LPA Colvin observed sufficient supply of perishable and non-perishable food and utensils and dishes for the residents in care. LPA Colvin observed a latch on the refrigerator which is capable of holding a lock to secure the refrigerator. Since LPA Colvin did not observe a lock on the latch, LPA Colvin is only issuing a Technical Assistance Advisory Note, recommending the facility to remove the latch. Planned Activities: LPA Colvin observed the facility's Activity Calendar as well as residents engaging in their own private activities in their rooms. Emergency Disaster Preparedness: LPA Colvin confirmed that the facility has an Emergency Disaster Plan on file with the Department, though staff present at the facility could not locate the file in the facility. Operational Requirements: The facility is licensed for 6 non-ambulatory residents and has a hospice waiver for up to 3 residents. LPA Colvin observed through review of the resident files that one resident (R1) is bedridden. The facility does not have bedridden fire clearance. Deficiency cited. Violations of the facility's fire clearance is considered a serious violation and is subject to an immediate $500 civil penalty, which LPA Colvin will be assessing today. Staffing & Staff Records: LPA Colvin confirmed that there are sufficient staff present to meet the needs of residents. LPA Colvin additionally confirmed that the facility has an Administrator with a current Administrator Certificate, though Licensing has not completed processing to update the Change of Administrator. LPA Colvin additionally observed that the acting Administration, Aurora Cuasay, is not associated to the facility. Deficiency cited. When there is a violation of criminal background clearance (such as staff not being associated), a civil penalty is assessed in the amount of $100 per day, per staff member, with a limit of $500 per staff member being assessed, unless the facility has repeated this violation in the last 12 months. Aurora Cuasay has been acting Administrator for the facility since late 2023, so LPA Colvin will be issuing $500 in civil penalties ($100 a day x 5). LPA Colvin additionally observed that at least one direct care staff (S1) does not have current CPR/First Aid Certification, as there's expired in 2023. Deficiency cited. LPA Colvin was unable to verify staff training as staff files were not available to LPA Colvin during today's inspection. Deficiency cited. Resident Records: LPA Colvin reviewed the files for all 4 current residents to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement, and current Needs & Services Plan. Resident files appeared to be complete and up to date. Incidental Medical Services: LPA Colvin observed that resident medication is locked in a cabinet in the kitchen and inaccessible to residents. LPA Colvin confirmed that the facility is not retaining any residents with prohibited health conditions. An exit interview was conducted with staff Higinio Alvarez (and Administrator Aurora Cuasay via telephone) and a copy of this report, LIC809D, LIC421BG, LIC421IMs, LIC9102, LIC9098 Proof of Corrections, and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 27, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.