Angel's Crest Home II

Type of visit: Required - 1 Year

On 7/20/2026 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Leonida Arinzane and explained the purpose of the visit. Administrator arrived later during the visit at 11:10am. The facility’s fire clearance was approved for all may be non-ambulatory and a hospice waiver for 2. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 77 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 at 110.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were unlocked and accessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 8/13/2025. Emergency Disaster Plan was last reviewed on 7/30/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 5/1/2026. LPA reviewed 3 of 3 residents records. LPA reviewed 3 staff records and 1 of 3 have current first aid training and 1 of 3 are associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed 2 individuals at the facility who are not associated (1 on shift and 1 in staff room; both stated they assist residents in care) no other staff present upon arrival LPA observed unlocked sharps and chemicals in facility kitchen LPA observed medications unlocked (med room unlocked/open and med cabinet also unlocked) LPA observed facility is pre-pouring meds for R2 and not keeping them in their original container S2 and S3 do not have files/training R1-R3 files incomplete ** Civil Penalties assessed $1000 for 2 individuals not associated to the facility*** Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 8/01/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 20, 2026

The state marks this report as 10 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 7/30/2025 at 10:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Grace Cuaresma and explained the purpose of the visit. Administrator arrived later during the visit. The facility’s fire clearance was approved for all may be non-ambulatory and a hospice waiver for 2. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 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 at 106.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week 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 detector were in operating condition during visit. Fire extinguisher was last serviced on 7/23/2024. Emergency Disaster Plan was last posted on 7/30/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 3/10/2025. LPA reviewed 3 of 3 residents records. LPA reviewed 2 staff records and 2 of 2 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, Jul 30, 2025

Type of visit: Required - 1 Year

On 9/13/2024 at 12:06 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Luz Ayuste and explained the purpose of the visit. LPA spoke with Administrator over the phone who gave permission to caregiver to sign report. The facility’s fire clearance was approved for all may be non-ambulatory and a hospice waiver for 2. LPA toured facility with caregiver including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 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 at 112 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week 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 detector were in operating condition during visit. Fire extinguisher was last serviced on 7/23/2024. Emergency Disaster Plan was last posted on 11/1/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 7/13/2024. At 12:11pm, LPA reviewed 1 of 1 residents records. At am12:20pm, LPA reviewed 2 staff records and 2 of 2 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, Sep 13, 2024

Allegation investigated: Staff inappropriately restrains resident in care.

On 4/25/2024 at 10:50AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct complaint investigation and to deliver complaint findings for the above allegations. At 11:30AM LPA met with Administrator, Marvie Fabie and explained the purpose of the visit. During the investigation LPA interviewed the Administrator and S1, reviewed resident records, and reffered to photos submitted by the RP. While interviewing S1 they disclosed that sometime last week the facility had a visit. During the visit S1 was questioned as to why R1 had a lapbelt keeping them on their wheelchair that latched in the back. S1 stated it was to protect them and that R1's responsible party requested the use of a lap belt. The visitor asked if R1 had a physicians order for the lap belt to which S1 said they did not know. Report continues on LIC9099C Substantiated While interviewing the Administrator they stated that R1 has dementia and kept falling. When R1 was put on hospice their responsible party inquired about options to help R1 from falling out of chairs. Administrator states that they informed the responsible party that restraints are not allowed but that the responsible party said it should be considered protection and comfort since R1 is on hospice. The Administrator acknowledges that the restraint was used improperly and that they will request an exception from CCLD to use a proper restraint. Administrator states that no restraints are/will be in use until an exeption is made. During the investigation LPA reviewed the records, physicians report and care plan for R1. LPA did not observe any documentation allowing restraints. R1 is on hospice. LPA also referenced photos submitted by the RP that shows R1 restrained in their wheelchair with the latch being wrapped around the bar behind the wheelchair where R1 can not reach it and easily get out. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Apr 25, 2024 · control 15-AS-20240419113325

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(2)(3) · Plan of correction due date: Apr 26, 2024

(a)Based on the individual's preadmission...Postural supports may be used under the following conditions.(2)Postural supports shall be fastened or tied in a manner that permits quick release by the resident.(3)A written order from a physician... The licensing agency shall ... verify the order. This requirement was not met as evidence by: Based on interviews, record review, and validated photos R1 was improperly restrained with a lap belt that did not offer quick release and did not have a physicians order.the state’s words, verbatim · CDSS document, Apr 25, 2024

Plan of correction: LPA observed that belt has been removed and Administrator agreed to request an expetion and physicians report before utilizing the lap belt.