Benevolence Board and Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced required 1-year visit to the facility. LPA met with Amanda Gonzales, Administrator and discussed the purpose of the visit. The facility is a Residential Care Facility for Elderly (RCFE). Licensed capacity of 6 with a current census of 5. LPA conducted an overall inspection of the facility, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 73 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as beds, mattresses, night stands, storage space, chairs and sufficient lighting. Bathrooms were clean and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested between 107 and 118 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents. All sharps are locked. There was a designated area for resident/staff files. Overall, the facility is clean, in good repair, and operating in a safe condition for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for the number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident files for admission agreements, updated physician reports, and needs and services plans. Resident files are maintained and up to date. LPA reviewed (3) resident medications. Medications are labeled and administered as prescribed. Medications are kept locked and inaccessible to residents LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Facility staff records are up to date. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C was discussed and provided to Administrator Amanda Gonzales.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Prelicensing

On 04/09/2025, Licensing Program Analyst (LPA) Becky Mann conducted an announced visit to the facility for purpose of Prelicensing evaluation. LPA met with Administrator Amanda Gonzales. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 09/01/2024 for a total capacity of six (6), six (6) Non-ambulatory. LPA observed the following: Structure: Facility has three (3) bedrooms, one (1) staff room, two (2) bathrooms, living room, dining area and kitchen. There's an attached garage. Bedrooms: Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were furnished with bed, mattresses, chair, closet, linens, adequate lighting and an operable dual smoke and carbon monoxide detectors. Bathrooms: The two (2) resident/staff bathrooms have a working toilet, wash basin, grab bars and shower. LPA verified water temperature was measured between 108 to 111 degrees Fahrenheit. Kitchen/Garage: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. Laundry detergents and cleaning supplies were observed in the garage in a locked cabinet. Living/Family room: There's a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens were stored in the facility. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle gate on left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted in the dining area. General items: One (1) fire extinguisher were charged. The smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Resident records and staff records will be stored in a locked cabinet in the kitchen area. First Aid kit with required components and locked area for medication storage was observed. LPA observed a facility phone, and which was operational. There is enough Emergency water supply and the required 72-hour emergency food supply for residents and staff available at the facility. Component III was completed on this day. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of residents in care. Facility is ready for licensure. An exit interview was conducted, and a copy of this report, LIC809 and LIC809C was discussed and provided to Licensee.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Amanda Gonzales, Managing Member/Administrator Interview Method: Telephone interview On 3/17/25, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 17, 2025