C & C Residential Care Home

Type of visit: Required - 1 Year

At approximately 9:45 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to BEGIN a required 1-Year annual inspection and was greeted House Manager Kaitlyn Destura who has Designation of Facility Responsibility (RP). RP called Licensee/Administrator Alma Corsiga to advise of today's inspection, Licensee was not available for today's portion of the annual inspection. LPA was informed there were four (4) residents in care; one Resident (1) was away at Day Program and three (3) were present during inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with an approved dementia plan and fire clearance capacity for six residents and can serve 6 non-ambulatory and 1 bedridden resident in room #1 only. Facilty has a hospice waiver for two (2) residents. At approximately 10:00 AM, LPA initiated a tour of the facility and observed the following: Facility is a one-story home, was a comfortable temperature, free of odors and passageways were free from obstructions. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars and non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods and a supply of non-perishable foods. Food was found stored and labeled per regulation. Medications were centrally stored and locked. Staff members had difficulty using the available keys to lock and unlock the medicine storage door and licensee is asked to consider upgrading lock to a system that is easier/quicker for staff to use. Continued on 809-C... Continued from LIC 809... There is outdoor space for activities. LPA observed toys, games, video games, and an ipad for resident use. An approximately three inch step into an outside activity structure was observed to now have a threshold transition to reduce the risk of tripping for residents. Facility has a fire extinguisher, which was last inspected May 2025 and is fully charged and licensee advised to call for re-inspection. The facilities fire extinguisher was found under the kitchen sink and licensee is advised to mount the extinguisher in a visually prominent area to allow for rapid use in an emergency situation. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Updated copies of the following documents were obtained today including: Updated copy of current liability insurance good through 05/07/2027 Updated LIC308 Designation of Facility Responsibility Updated LIC610E Emergency and Disaster Plan LPA will return at a later unannounced date to complete the annual inspection and will request copies of LIC500 Personal Roster and LIC 9020 Resident Roster at that time. *No Deficiencies are being cited today. Exit interview conducted with RP, whose signature on this document confirms receipt.the state’s words, verbatim · CDSS document, Aug 10, 2026

Allegation investigated: Resident's hygiene care needs are not being met.

At approximately 01:30 PM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver complaint findings of a complaint received by Community Care Licensing on 01/08/2026. Complainant alleged neglect/abuse of resident (R1) including poor incontinent care citing the use of two incontinent briefs with the client arriving to a local hospital with the two (2) briefs soaked with urine and fecal matter going up the front and back of R1’s clothes. Interview with complainant revealed that R1 was otherwise in good condition and with R1’s groin and perianal area without redness, irritation, sloughing or urine scalding. Complainant also revealed that EMT staff will often relay if a community care home is run down, dirty or in bad shape. Complainant offered that EMT staff made no such claims about the facility R1 had come from. Continued on LIC9099-C Unsubstantiated Continued from LIC9099 During LPA’s unannounced complaint inspection, LPA noted facility to be very clean and without urine or fecal odors. Facility had very organized incontinence care items in each resident’s rooms including incontinence briefs with nylon Velcro-like attachments, Prevail-brand daily pant (incontinence brief) liners without velco-like attachments and “cloth-like outer fabric”. In addition, resident rooms and a separate supply area was noted to have incontinent wash spray and antibacterial barrier skin creams. Interview with resident R2 indicated no concern about their incontinence care at the facility. During the course of the investigation LPA obtain R1’s Physician’s Assessment and Care Plan that indicated the need for help with bowel and bladder incontinence care, including help with incontinence briefs and help with toileting and grooming. In addition, R1 was noted to be on a pureed/liquid/thickened diet and took PRN medicines for anxiety. Interviews with S1 and S2 reveal that on the morning of R1s admission to the hospital, R1 had an incontinence brief and an additional incontinence liner as a precaution for travel to day programming. On that morning R1 had vomited and began to become short of breath with a temperature of 101.5F and 911 was contacted. Staff noted that R1 was incontinent of bowel and bladder and while taking vitals, R1 vomited and began to slump in the arms of facility staff. Staff S1 and S2 expressed an immediate urge in a situation that felt dire, to help R1 onto an awaiting EMT gurney and get R1 to the hospital. S1 and S2 acknowledged that facility residents are always ensured to be clean and dry, especially for outings like day programming or medical visits, but on this day, it did not make sense for R1, given the urgent nature of their concerns for R1, R1’s history of anxiety and R1’s preference to be changed in standing positing. The allegation is Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. This report was reviewed with Licensee/Administrator Alma Corsiga, whose signature denotes receipt.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 21-AS-20260108102834

Type of visit: Required - 1 Year

At approximately 9:35 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-Year Visit and was greeted by a caregivers. Alma Corsiga, Licensee, was contacted by phone and arrived at approximately 9:50 AM. LPA was informed there were five (5) residents in care; two (2) were away at Day Program and three (3)) were present during inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with an approved dementia plan and fire clearance capacity of six (6) non-ambulatory residents and hospice waiver for two (2) residents. At approximately 10:00 AM, LPA initiated a tour of the facility and observed the following: Facility is a one-story home, was a comfortable temperature, free of odors and passageways were free from obstructions. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. Facility has at least two days of perishable foods and a supply of non-perishable foods. A large approximately one (1) foot long fish that a staff member had caught was observed to be wrapped in an absorbable cloth chux in the freezer and not stored in an air tight bag and labeled with the date per regulation (Type B) deficiency cited. Medications were centrally stored and locked. There is outdoor space for activities. LPA observed toys, games, video games, and an ipad for resident use. In addition LPA observed an activity schedule, as well as, an opportunity for residents to attend area swim programming. An approximately three inch step was observed leading to an outside activity/office building that poses a potential trip hazard and a technical advisory was issued to install a small transition step or hand railing to reduce the threat. Facility has a fire extinguisher, which was last inspected May 2025 as is fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on 809-C... Continued from LIC 809... At approximately 11:30 AM, five (5) of 5 resident files were reviewed and observed to have required documentation. Licensee states, facility coordinates the residents' medical and dental appointments as needed and provides transportation to and from these visits. At approximately 12:00 PM LPA initiated file review of five (5) personnel files and 2 of 5 observed, staff one and staff 2 (S1) and (S2)) had no evidence of health screening or TB testing (Type A) citation issued. In addition 2 of 5 staff files observed to be missing evidence of 1st Aid training and intial education training and technical violation issued. LPA observed medicines to by centrally stored and secure and administered correctly. P&I money was accounted for and licensee was on the phone during my inspection to secure additional surety bonding to match the amount of money safeguarded in the facility and will send in new bond to Community Care Licensing (CCL) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights provided to Licensee. Exit interview conducted with Licensee, whose signature on this document confirms receipt. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC 500 Personnel Record LIC 9020 Register of Facility Resident’s was obtained during inspection today. Updated Surety bond for higher amount. *Updated copy of current liability insurance was obtained during inspection today.the state’s words, verbatim · CDSS document, Jul 22, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a 1-Year Required Visit and was greeted by a caregiver. Alma Corsiga, Licensee, was contacted by phone and arrived at approximately 9:45 AM. LPA was informed there were six (6) residents in care; two (2) were away at Day Program and four (4) were present during inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with an approved dementia plan and fire clearance for capacity of six (6) non-ambulatory residents. At approximately 10:00 AM, LPA initiated a tour of the facility and observed the following: Facility is a one-story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. LPA observed three residents in their respective beds. Two of whom showed their ability to move and reposition themselves. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed unlocked. Licensee had staff remove the items immediately and place them in a locked cabinet. Facility has at least two days of perishable foods and a supply of non-perishable foods. Medications were centrally stored and locked. There is outdoor space for activities. LPA observed toys, games, video games, and an ipad for resident use. Facility has a fire extinguisher, which was last inspected May 2024 as is fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on 809-C... Continued from LIC 809... At approximately 12:15 PM, five (5) resident files were reviewed. LPA observed one (1) resident (R1) file with a physician's medical assessment from May 2024 indicating said resident is bedridden. Facility's fire clearance does not contain approval for bedridden residents. LPA observed 3 of 5 resident files missing the required I.D. and Emergency Information form and 5 of 5 resident files were missing consent for emergency medical treatment. LPA observed all the remaining required documentation per regulation in five (5) of five (5) resident files. Licensee states facility coordinates the residents' medical and dental appointments as needed and provides transportation to and from these visits. At approximately 1:45 PM LPA initiated file review of five (5) personnel files but was unable to complete the review. LPA was also unable to review medications, P&I, and facility's emergency disaster drill log and will return at a later date to complete annual inspection. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights provided to Licensee. Exit interview conducted with Licensee, whose signature on this document confirms receipt. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC 200 Request for Bedridden Fire Clearance LIC 999 Updated Facility Sketch LIC 500 Personnel Record (updated) LIC 610 Emergency Disaster Plan (updated) LIC 9020 Register of Facility Resident’s Proof of Liability Insurancethe state’s words, verbatim · CDSS document, Aug 1, 2024