Angels Care Guest Home II

Type of visit: Required - 1 Year

On July 20, 2026, Licensing Program Analysts (LPAs) Brandon Lopez and Tran Nguyen made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee (LI) Ruby Cruz was notified via telephone and later arrived to assist with the inspection. LPAs observed that Janice Jabonero has a valid administrator certificate which expires on March 25, 2028. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden in room three, and has am approved hospice waiver for six. The facility is a single story home with four resident bedrooms, two of which are shared, two shared resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPAs, accompanied by a care giving staff, conducted a tour of the interior portion of the facility. On today's visit, LPAs observed six residents in care and two care giving staff present. LPAs observed residents relaxing in the living room. LPAs observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPAs inspected the four resident bedrooms and they were observed to be free of hazards. LPAs observed residents bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPAs observed resident beds had clean linens and blankets. LPAs observed additional linens to be stored in a cabinet. LPAs inspected the two resident bathrooms. Resident bathrooms were clean. Resident bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 110 and 112.4 degrees Fahrenheit. LPAs observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPAs observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C LPAs observed kitchen knives and sharps to be stocked in a locked kitchen cabinet. LPAs observed a fire extinguisher to be mounted in the kitchen and it was observed to be charged and serviced as of February 5, 2026. LPAs tested the wired smoke detectors and carbon monoxide detector which tested operational. LPAs observed the facility conducted their last emergency disaster drill on May 1, 2026. LPAs observed the centrally stored medication to be kept in a locked closet located by the dining room. LPAs observed the facility has a first aid kit stored in the locked closet and it had all the required components. LPAs observed chemicals and toxins to be stored in a locked cabinet located by the attached two car garage. LPAs observed the garage door to be kept locked and inaccessible to residents in care. LPAs observed the garage to be used for storage. LPAs observed the facility has a three day emergency food and water supply stored in the garage. LPAs, accompanied by a care giving staff, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPAs observed a shaded outdoor seating area with furniture for resident use. LPAs observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPAs reviewed all six resident files. All the required documentation were present and current in the resident files reviewed. LPAs reviewed residents' medication and medication administration records. LPAs reviewed six staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, no deficiencies are being cited per the Title 22 of the California Code of Regulations. An exit interview was conducted with an authorized facility representative and a copy of the report was provided at time of visit.the state’s words, verbatim · CDSS document, Jul 20, 2026

Allegation investigated: Due to neglect, resident sustained a pressure injury

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegation listed above. LPA met with Licensee Ruby Cruz and explained the reason for the visit. The investigation into the allegation revealed the following. Resident 1 (R1) moved into the facility on October 1, 2023. R1 was admitted to hospice when they moved into the facility. R1 was diagnosed with Parkinson Disease. A hospice nurse visited R1 twice a week. Staff interviewed reported they followed all hospice orders and wound care orders for R1. The Administrator reported that facility staff followed all the orders from hospice and wound care and R1 was cleaned and changed regularly. A review of records shows that R1 was diagnosed with a new pressure injury in the coccyx area on December 24, 2023. R1’s responsible party reported they were notified by hospice on December 30, 2023, of a stage 2 pressure injury and that treatment was started. Hospice ordered the resident to be clean, and dry and the wound area to be cleaned and dried daily along with new bandages every day and for R1 to be repositioned every 2 hours. On January 29, 2024, hospice orders indicate that the pressure injury should be cleaned and bandages changed every day and describe the pressure injury as stage 2/3. Substantiated On February 2, 2024, a referral to wound care was submitted and R1 was accepted into wound care on February 7, 2024. R1 was still on hospice to manage their comorbidities. R1 was visited by a wound care nurse once a week from February 7, 2024, to May 2, 2024. Records were requested for the visit that should of took place on May 9, 2024, but none were provided. A review of records shows the wound progressed from stage 2 to stage 3 and then unstageable and increased in size. On February 29, March 7, April 11, April 18 the wound was listed as improving, but overall, the wound increased in size and on April 26, 2024, the wound was diagnosed as infected. On May 18, 2024, the responsible party requested R1 be transferred to the hospital because the wound was not healing. R1 was diagnosed with a wound on December 24, 2023. Under hospice care the wound did not improve and wound care was ordered and approved. Under wound care the wound did not heal, increased in size and finally became infected and R1 was sent to the hospital due to the wound. Even though the staff rotated R1 as directed by hospice and wound care, R1’s wound never improved at the facility. It is unknown how often the wound was cleaned and bandages changed. A review of the photographic evidence shows the wound increased in size from February 2, 2024, to May 2, 2024. After 2 months of treatment the wound did not improve and increased in size, the resident remained at the facility and no changes to R1's plan care were made. The resident was on hospice but none of the notes show the resident was having any issues with their primary diagnosis of Parkinson Disease. On May 18, 2024, the resident was transported to the hospital at the request of the responsible party. The responsible party reported that once they notified the primary care physician of the situation they recommended R1 be transferred to the hospital. Facility staff reported that they were informed that R1 was being transferred to the hospital. After R1 was transferred it is unknown what happened to R1. R1’s responsible party did not respond to requests for an interview after May 28, 2024. The hospice nurse listed in the hospice records did not respond to requests for an interview. The wound care nurse interviewed had no direct knowledge of Resident 1 but assisted in providing the records. Based on the evidence gathered the preponderance of evidence standard has been met; therefore, the allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Immediate civil penalties are being assessed. See LIC421IM. A Civil Penalty is pending determination by the Community Care Licensing Division (CCLD) per Health & Safety Code section 1569.49(f). An exit interview was conducted, and a copy of this report and appeal rights were discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 22-AS-20240521100241

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Feb 12, 2026

Basic services shall at a minimum include: (1) Care and supervision… This requirement was not met as evidenced by: Based on the evidence gathered, the licensee did not ensure R1 received care and supervision, as a result R1 suffered a pressure injury that required hospitalization, which poses an immediate health and safety risk to persons in care. CIVIL PENALITY ASSESSED.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: Licensee agrees to train care staff on CCR 87464 and to submit proof of training to LPA.

Type of visit: POC

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a proof of correction visit. LPA met with Administrator Janice Jabonero and explained the reason for the visit. Facility was cited on August 14, 2024. LPA and Administrator toured the facility. LPA measured the hot water. The hot measured 113.9 degrees Fahrenheit in both bathrooms. LPA observed all medication is kept secured and stored in it's original container. LPA cleared both citations. LPA observed the garage no longer has any rooms in it. The garage is one single open area with no interior walls. LPA consulted with Administrator regarding the process to receive a new fire clearance showing the garage will only be used for storage and not a work/living area for staff. Administrator agreed to complete a new LIC 200 including a facility sketch to submit to the Agency (Community Care Licensing) to request a new updated fire clearance. No health and safety concerns observed during the visit. No obstacles or hazards observed inside or outside of the facility. LPA consulted with Administrator concerning reporting requirements. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided along with proof of correction letter to the Administrator.the state’s words, verbatim · CDSS document, Dec 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to perform the required annual inspection. Upon arrival, the LPA was greeted by staff member Roleando Aquino, who granted access. The LPA explained the purpose of the visit, and shortly thereafter, Licensee Ruby Cruze arrived.The facility is a single-story residence consisting of six bedrooms, four of which are designated for client use, and two bathrooms. All client bedrooms were observed to be appropriately furnished, including beds equipped with necessary linens and blankets. All windows throughout the facility were screened, and the backyard featured a shaded seating area.At the time of the visit, one staff member and two clients were present. The facility has a total census of four clients, with two attending an off-site day program. Both bathrooms were observed to be clean and free of debris and mildew. All faucets and toilets were in proper working condition, and the hot water temperature measured at 105DF. Smoke detectors and carbon monoxide detectors were observed in all client bedrooms and common areas. Each device was tested and confirmed to be operational. The facility had an adequate stock of bath towels and personal hygiene supplies. Common areas were clean, free of hazards, and all passageways and doorways remained unobstructed.The facility’s first aid kit was fully stocked with all required items. All kitchen appliances were in good working order. The LPA observed an adequate food supply, consisting of at least a two-day supply of perishable items and a seven-day supply of non-perishable goods, meeting regulatory requirements. Knives, sharps, and toxic substances were secured in separate locked cabinets within the garage, making them inaccessible to clients.A review of two client files and two staff files was conducted. All files contained the required documentation. The Administrator’s certificate was current, with an expiration date of March 25, 2025.The fire extinguisher was fully charged and had been last serviced on March 14, 2025. The most recent fire drill was conducted on July 1, 2025, and records indicated that drills are performed quarterly by the Administrator.Based on the observations made during the inspection, no deficiencies were cited in accordance with the California Code of Regulations, Title 22, Division 6. An exit interview was conducted, and a copy of this report was provided to the Licensee.the state’s words, verbatim · CDSS document, Jul 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted by staff and granted entry. LPA informed staff of the reason for the visit. Staff called the Administrator and informed them of the visit. LPA and staff toured the facility. Ruby Cruz arrived during the visit and LPA explained the reason for the visit. The facility has 4 resident bedrooms, 2 bathrooms, living room, dining room, kitchen and an attached 2 car garage. LPA observed the See Something Say Something poster (PUB 475) posed next to the front door. LPA and staff toured the garage. LPA observed the garage has two new rooms. Staff reported that staff live in the 2 rooms. LPA observed each room has a locking door and has a bed and nightstand. Each room has a smoke detector. The main garage door can be opened and closed. There is also an exit door leading to the backyard. The washer and dryer are in the garage. The 2 rooms in the garage are not on the original facility sketch that was submitted with application to be licensed. LPA observed the resident rooms were clean and organized. Both bathrooms are clean and organized. Hot water measured 129.3 degrees Fahrenheit in bathroom 1 and 129.5 degrees Fahrenheit in bathroom 2. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The 4 burner gas stove lights unassisted. The fire extinguisher in the kitchen is fully charged. LPA observed the medication is kept locked in the hall closet. LPA observed the living room has 2 couches, a table and a large screen TV. There is no fireplace in the facility. LPA and staff toured the backyard. The exit gate is operational and self closing. No bodies of water observed. There are two tables with umbrellas and chairs to provided shaded seating on the deck. No obstacles or hazards observed in the backyard. The smoke detectors/carbon monoxide detectors tested operational. LPA reviewed 5 resident medications. LPA observed that 2 tablets and 1 capsule for Resident 1 (R1) are being stored outside of their original container and kept in a plastic pour cup with a lid. LPA reviewed 5 resident records, no discrepancies observed. LPA reviewed 3 staff files, no discrepancies observed. All staff files reviewed had the required training. LPA inspected the first aid kit. The first aid kit had all the required elements. The last fire drill took place on August 4, 2024. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Aug 14, 2024