Aviation Guest Home

Type of visit: Required - 1 Year

On 04/24/26, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with House Manager Gat Dilag. The facility is licensed to serve six residents age range 60 and over. Six residents may be non-ambulatory of which one may be bedridden. The facility has a hospice waiver approved for four residents. Annual fees are current. The facility is a single-story home consisting of: four resident bedrooms, one staff room, two full bathrooms, living room, kitchen with dining area, laundry room (located in the attached garage) and an outdoor shaded patio area. The House Manager accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards, doorways were free of obstructions. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Continue to LIC809-C. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, a non-skid mat was in place, and hot water temperature properly measured at 107- degree Fahrenheit. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked cabinet. First Aid kit was available. Two fire extinguishers, last serviced 08/22/25, were observed near room one and in the kitchen area. House Manager tested the carbon monoxide and smoke detectors in the house. Both devices were functional. Five staff records were reviewed, five out of five staff records had current first aid certificates and required criminal record clearances or criminal record exemptions. Four resident records were reviewed, four out of four resident records had medical assessment/hospice plan of care and pre-appraisal or reappraisals. Two residents’ medication was reviewed. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with the House Manager Gat Dilag.the state’s words, verbatim · CDSS document, Apr 24, 2026

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 09/29/2025 around 09:00am Licensing Program Analyst (LPA) Jose Calderon initiated an announced Case Management - Other to Aviation Guest Home provide Technical Assistance to the above said facility. The LPA Calderon requested copies of the facility's records which include but are not limited to Staff roster, LIC500, pre-placement appraisal, physician report for 5 residents. LPA Calderon conducted a tour of the facility with Manager Gat Dilag. An exit interview was conducted with Manager Gat Dilag and a hard copy was provided via email for signature.the state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: Case Management - Annual Continuation

On 02/21/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced annual continuation inspection and met with House Manager Gat Dilag. First Aid kit was available. Two fire extinguisher, last serviced August 6, 2024 was observed near room one and in the kitchen area. Five (5) staff records were reviewed, 5 out of 5 staff records had current first aid certificates and required criminal record clearances or criminal record exemptions. Four (4) resident records were reviewed, 4 out of 4 resident records had medical assessments and pre-appraisal or reappraisals. Two residents’ medication was reviewed. No deficiencies were cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with the House Manager Gat Dilag.the state’s words, verbatim · CDSS document, Feb 21, 2025

Type of visit: Required - 1 Year

RCFE Sample Inspection Licensing Program Analyst (LPA) Troy Watson and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one year inspection. LPA met with the administrator Irene Formentera, and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents of which one may be bed ridden and the facility has an approved hospice waiver for four residence. Four residents are diagnosed with dementia and three residents are receiving hospice care services. The facility does not handle any of the residents’ money. This home is a single story home consisting of: (4) resident bedrooms, (1) Full bathroom, 1 half restroom, living room, kitchen with dining area, laundry room (located in the attached garage) and an outdoor shaded patio area. The resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 115.1F – 116.4F. Residents bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. No bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. No Deficiencies cited: An exit interview was conducted and a copy of report provided.the state’s words, verbatim · CDSS document, Apr 10, 2024