Angelicum RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with Administrator, Vivian Reyes. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of four (4) resident bedrooms, a staff area, three (3) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, and a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 109.4 degrees F. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats present. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home and no bodies of water observed. LPA began review of client records. two (2) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. LPA began review of employee records- Three (3) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 05/26/2026. LPA observed personnel records to be available and complete. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals and sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the hallway allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers was serviced on 01/14/2025. Emergency drills are conducted quarterly at the facility with the last drill on 07/03/2025. Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Sep 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon, Andrei Castillo, and Ferrer Sabarias conducted an unannounced annual required visit. Upon entry, LPAs were greeted by Vivian Reyes, administrator, and informed them of the purpose of the visit. At the time of the visit, there were two staff members and two residents present. Facility Overview: The facility is a one-story home with four bedrooms and three bathrooms, including an attached garage. There are no pools or firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Fire extinguisher located in the kitchen had current inspection tag. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 120°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for two staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Two resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. However, a staff's prescription medication bottles were stored in a drawer in the kitchen that was accessible to the residents in care. Citation was issued. LPA reviewed medications for two residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-6-2024, which met department requirements. All facility exits were clear of obstructions. One deficiency was cited during the visit. An exit interview was conducted, during which this report, LIC809-D and Appeals Rights were reviewed and provided.the state’s words, verbatim · CDSS document, Oct 21, 2024

Type of visit: Required - 1 Year

On 10/19/2023, Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Vivian Reyes, who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (6) residents present. The facility is a one story home with (4) bedrooms and (2) bathrooms. No pools or firearms are present. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: Infection Control: The LPA observed hand washing stations with hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a plan to train and follow infection control guidelines. Physical Plant: Physical plant was observed to be clean and in good repair. The indoor and outdoor areas were observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The smoke detector and carbon monoxide was operational, and the hot water temperature was recorded at 105.4F. 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. Record Review and Resident/Staff Files: LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. The listed administrator has a current administrator's certificate. Resident files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: The following issues will be cited. Based on interview with Administrator and records review, this PRN was not authorized by Resident 1 (R1)'s primary care physician. The facility currently has a waiver for three (3) hospice residents, however based on interview with administrator the facility currently has (5) residents on hospice. The administrator stated they sent a waiver increase letter that was sent to the department but was unable to provide a copy during the visit. According to California Code of Regulations Title 22, a licensee shall not retain a hospice resident without first securing a hospice waiver from the department. Plans of correction were created with the administrator for these deficiencies. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The last fire drill was conducted 7/18/23, the facility is due for another fire drill this month. LPA will document Technical advisory note and administrator agreed to hold fire drill by 10/31/2023. LPA observed emergency exits and emergency supplies. The licensee currently has not paid their annual fees. The administrator was able to show proof of sending a payment 8/23/2023. LPA provided balance information and how the payment can be made or disputed with the department. An exit interview was conducted where a copy of this report, along with LIC809-D page, and appeal rights were provided to Administrator, Vivian Reyes.the state’s words, verbatim · CDSS document, Oct 19, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.