Angels Care Home

Type of visit: Required - 1 Year

On 01/07/2026 at 12:40 PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced required annual inspection. LPA met with Caregiver, Liezyl Ajos and explained the purpose of the visit. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. No bodies of water observed. A comfortable temperature is maintained at 70 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 123.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 12/08/2025. Emergency Disaster Plan was last reviewed on 12/28/2025. First aid kit was observed to be complete. Fire drill was last conducted on 10/17/2025. Continued on LIC809. Continued from LIC809. Four (4) staff records were reviewed, current, and complete. LPA reviewed three (3) resident records were reviewed. LPA requested the following documents to be submitted to CCLD by 01/14/2026. LIC308 Designation of Administrative Responsibility LIC610E Emergency Disaster Plan (last page) Liability Insurance LIC500 (Personnel Report) LPA observed the following deficiencies: At 1:37pm, LPA observed kitchen drawers had insects. At 1:39pm, LPA observed refrigerator to be unsanitary.] At 1:44pm, LPA observed shed in backyard unlocked. LPA also observed small Rubbermaid shed in backyard unlocked. At 1:50pm, LPA observed during record review R1 did not have an order for half bed rails. At 2:15pm, LPA observed facility did not have a qualified administrator. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Case Management - Incident

On 10/07/2025 at 10:47AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 10/05/2025. LPA met with Liezyl Ajos Administrator and explained the purpose of the visit. Incident report dated 10/05/2025 revealed that R1 went outside of the facility R1 was found by Brentwood Police officer(BPO) who brought R1 back to the facility. BPO did not leave a report number or contact number. Facility notified R1’s responsible party and Licensing. LPA interviewed staff (S1), obtained and reviewed documents provided which included physician's report, appraisal needs and services, staff schedule and resident’s roster. The following deficiency were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiency by POC date and/or any repeat deficiencies within a 12-month period may result in additional Civil Penalties. Exit interview conducted and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Oct 8, 2025

(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement.. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above by not having an auditory device or other staff alert feature to monitor all exits on exterior doors, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Administrator agreed to purchase an auditory device for front door and send CCLD an email photo by POC date.

Type of visit: Required - 1 Year

On 01/26/2024 at 10:15AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Liezyl Ajos and explained the purpose of the visit. Administrator currently holds certificate #7019104740 Expires:12/10/2025. The facility’s fire clearance was approved for 6 non-ambulatory residents. LPA toured facility with Liezyl including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms which four (4) bedrooms are occupied by the residents and two (2) bedrooms are occupied by staff. Staff occupy the bedrooms upstairs; upstairs is not accessible to residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured 115.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/13/2023. Emergency Disaster Plan was last posted on 10/11/2024. First aid kit was observed to be complete. Fire drill was last conducted on 10/11/2024. Continue on LIC809C Continued from LIC809 LPA reviewed six (6) residents records. LPA reviewed three (3) staff records and (3) of (3) have current first aid training and associated to the facility. LPA requested the following documents to be submitted to CCLD by 01/09/2024. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (last page) · Liability Insurance LPA observed the following deficiency: At 12:46PM LPA observed during record review two (2) out of three (3) staff members didn't have the yearly eight (8) hours of in-service training documented in files.. The following deficiency were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiency by POC date and/or any repeat deficiencies within a 12-month period may result in additional Civil Penalties. Exit interview conducted and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 2, 2025

Allegation investigated: Resident left unattended in bathroom

On this day at around 10:10 am, LPAs Luisa Fontanilla and Tonica Syess-Gibson arrived unannounced to conduct investigation on the above allegation. LPAs met with Liezyl Ajos. LPAs explained to Ajos the purpose of the visit. During the course of investigation, LPAs reviewed records and interviewed Resident 1 (R1) and two staff(S1 and S3). LPAs reviewed R1's 2023 Physician's Report and Service Plan. Based on record review conducted, R1 has Dementia and needs assistance with activities of daily living (ADLs). On 5/31/2024, S1 states R1 was assisted by S2 to the bathroom then waited outside the bathroom with the door ajar. S3 then came to switch with S2 to assist R1 as R1's preference is a female staff. S3 noticed the door was locked and could not open the door. S3 asked assistance from other staff to get the door opened. continuation on Lic 9099C Unsubstantiated S1 and a hospice nurse who was at the facility responded and were able to open the door. LPAs interviewed the nurse who states that R1 was inside the bathroom for approximately 5 minutes. The nurse states R1 was observed smiling and sitting on the toilet when the door was opened. Staff interviewed denied leaving R1 in the bathroom unattended. Staff stated the door was accidentally locked by one of the residents but has been replaced by new hardware that doesn't require a key when locked. LPAs interviewed R1 who states that R1 likes and feels safe living at the facility. R1 states R1 likes the staff. However, R1 states that R1 prefers a female caregiver. R1 does not recall the incident that happened on May 31, 2024 when R1 got locked in the bathroom. Based on interviews and record reviews conducted, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 13, 2024 · control 15-AS-20240603164253

Type of visit: Required - 1 Year

On 01/26/2024 at 12:25 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Liezyl Ajos and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non Ambulatory. LPA toured facility with Liezyl including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 4 bedrooms are occupied by the residents and 2 bedrooms are occupied by staff. Staff occupy the bedrooms upstairs, upstairs is not accessible to residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured 119.3 degrees Fahrenheit and 120 degrees Fahrenheit in master bathroom. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 10/11/2023. First aid kit was observed to be complete. LPA reviewed 5 residents records. LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 26, 2024