Angels Care Guest Home

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Licensee (LE) Ruby Cuz and discussed the purpose of the inspection. Administrator (AD) Janice Jabonero arrived during the inspection. LPA reviewed Infection Control requirements. At about 2:00PM, LPA and LE conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 5-bedroom, 2-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 6 residents present at the facility. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 110 and 113 degrees F the two resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 3:00PM, LPA reviewed 6 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 6 residents. Facility does not handle resident money. During the inspection, LPA and LE observed the following: based on observation, the facility's only side exit which is to be used as an emergency exit was dead-bolted shut. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Office

An informal conference was conducted on this date in the Orange County Adult and Senior Care Regional Office. The purpose of this informal conference was to discuss concerns regarding the ownership and operation of the licensee GRANNY'S HOMES INC. Present during this meeting were Regional Manager (RM) Marina Stanic, Licensing Program Manager (LPM) Lourdes Montoya, Licensing Program Analysts (LPAs) Sean Haddad and Eboni Bentley, and GRANNY'S HOMES INC’s Chief Executive Officer (CEO) Quintin Jeffrey Clavecillas, Chief Financial Officer (CFO) Ruby Lyn Cruz, and Administrator (AD) Janice Jabonero. The purpose of today’s meeting was to discuss the ownership and operation of the licensee GRANNY'S HOMES INC. During the informal conference, the following items were discussed: The ownership and operation of the licensee GRANNY'S HOMES INC. CEO and CFO will submit to LPA the following documents by close of business October 30, 2024: all bank statements for the licensee GRANNY'S HOMES INC’s bank account from the date the account was opened to the present; certified copies of financial statements for the licensee GRANNY'S HOMES INC from the date of incorporation to the present; and a copy of the board minutes with the decision for the next steps of the licensee GRANNY'S HOMES INC. An exit interview was conducted and a copy of this report was discussed with and provided to CEO, CFO, and AD.the state’s words, verbatim · CDSS document, Oct 23, 2024

Allegation investigated: Facility staff is financially abusing resident

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on February 06, 2024. LPA was greeted and granted entry into the facility and met with Licensee Ruby Cruz. LPA explained the reason for the visit. This Department has investigated the complaint alleging that facility staff is financially abusing resident. Resident 1 (R1) was admitted to the facility on August 30, 2023. Documents reviewed included the Physician Report (LIC602) dated August 30, 2023 for R1. Per Physician report R1’s diagnoses is malignant neoplasm of left kidney and is not able to manage own cash resources. During the course of the interviews with residents, R1 reported that facility staff is not financially abusing R1. R1 is upset because R1 no longer has access to the bank account and reported that the friend manages R1’s money. R1 reported that his friend manages his money and stated that his friend is his trustee. During the course of the interviews with witnesses, Witness 1 (W1) reported that R1 was denied access to R1 funds by the bank because CONTINUED ON LIC9099-C... Unsubstantiated R1’s Primary Care Physician (PCP) indicated on the last physician report that R1 requires assistance when managing own cash resources. Per W1 there is no proof that Staff 1 (S1) demanded R1 to withdraw $20, 000 and place it in another account. W1 has stated that a few months ago R1 was given a $500 visa gift card. W1 confirmed the visa gift card did not indicate that S1 used the gift card for S1 personal use. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with Licensee Cruz, and a copy of this report was provided to the facility. Per W1 R1 is happy with the company of S1. During the course of the interviews, AD stated that S1 did not displayed inappropriate behaviors towards R1. Per AD staff are respectful. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to insufficient evidence. Therefore, the allegation has been deemed to be UNSUBSTANTIATED. LPA Ramirez conducted an exit interview with Licensee Cruz, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 20, 2024 · control 22-AS-20240206120108

Allegation investigated: The facility failed to issue a refund

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and RoseMarie Ruppert for the purpose of investigating the above-mentioned complaint allegation. LPAs met with Licensee (LE) Ruby Cruz and Administrator (AD) Janice Jabonero and explained the reason for today’s inspection. The investigation into the allegation that the facility failed to issue a refund revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed LE, AD, and witnesses, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Admission Agreement dated March 16, 2024. CONTINUED Substantiated Regarding the allegation that the facility failed to issue a refund: it was alleged that R1 moved into the facility on March 16, 2024, went to the hospital on April 1, 2024, did not return to the facility, R1’s responsible party moved R1 out of the facility and removed R1’s belongings from the facility on April 3, 2024 and requested a refund on that date, but the facility did not provide a refund. LPAs interviewed a witness who confirmed these details. LPAs attempted to interview R1, but R1 is no longer present at the facility. LPAs interviewed LE and AD who corroborated these facts, but denied that a refund was required because no notice was provided. LPAs reviewed R1’s Admission Agreement dated March 16, 2024 which states: “REFUND/PRORATION POLICY. If the resident moves out, the basic rate will continue to accrue until all personal belongings are removed from the facility. Unused rent moneys will be returned fifteen (15) days after room is vacated of all belongings, clothing and furnishings.” Based on R1’s Admission Agreement dated March 16, 2024, no notice was required and the facility should have issued a refund for prorated unused fees starting on April 4, 2024. During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. Regarding the allegation that the facility is being operated by an unauthorized individual: it was alleged that the licensee, Granny's Homes Inc, is a corporation, but when the facility requested payment for Resident #1’s (R1) fees, the facility requested that the check be made out to LE, an individual. LPAs interviewed AD who did not have information regarding this allegation. LPAs interviewed LE who admitted these facts and stated that they asked for the money personally in order to give it to a referral agent for a referral fee, but stated that they are the owner of the licensee corporation Granny's Homes Inc. LPAs reviewed the facility’s Administrative Organization (LIC309) dated January 10, 2018 and Articles of Incorporation dated March 20, 2017 which show that LE is a 50% owner of the licensee corporation Granny's Homes Inc, meaning LE is an authorized individual to operate the facility. The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 7, 2024 · control 22-AS-20240430121216

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5) · Plan of correction due date: Jun 4, 2024

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions. This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not follow the admission agreement when they did not provide R1 with a refund after they moved out of the facility, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 7, 2024

Plan of correction: Licensee stated they will refund prorated unused fees starting on 04/04/24 to R1 and submit proof to LPA by POC due date.

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Janice Jabonero and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 2:30PM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 5-bedroom, 2-bathroom, one-story house with attached garage that is being used for storage. There is a back yard with a patio cover for the residents. LPA and AD observed 2 staff and 6 residents present at the facility. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 106 degrees F and 107 in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen, after corrections. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 3:00PM, LPA reviewed 6 resident files and 2 staff files, interviewed 6 residents and 1 staff, and inspected medications for 6 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on observation, the lock for the knife drawer in the kitchen was not present and could not be located by staff, leaving the knives accessible to residents some of whom have dementia. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Apr 19, 2024