Cali Care Retirement Home

Type of visit: Required - 1 Year

On 10/15/2025, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator Cynthia Mojica and explained the purpose of the visit. The administrator assisted with today’s visit. The current census is 6 with 2 facility staff. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 112.6 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mats were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the common area and was last serviced on 12/02/2024. LPA Lee observed the facility has a has a public telephone in the kitchen and common area and the facility has the required posters posted. Facility thermostat was observed at 72 degrees Fahrenheit. LPA Lee observed toxins located in laundry and kept locked and inaccessible to residents. CONTINUED LIC 809-C LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 3 resident medications and medication administration record (MAR) and it was complete. The first aid kit was checked and contained the required components. LPA Lee requested resident and staff files for review. LPA Lee reviewed 6 out of 6 resident files and they were complete. LPA Lee reviewed 4 staff files, and it was completed. LPA Lee reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated with the facility. The following documents will be emailed to LPA by end 11/22/2025 of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with administrator Mojica, and a copy of these LIC 809 reports were provided to the facility.the state’s words, verbatim · CDSS document, Oct 15, 2025

Type of visit: Case Management - Other

On 7/11/2025 Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannouced to the facility to conduct a case management visit. The purpose of this visit was to check an updated fire clearance. Facility care staff called the facility designated administrator to inform that CCLD was present in the facility. The current census is 5 with 2 facility staff. This facility is a single story building licensed to serve (5) non-ambulatory residents. LPA inspected resident bedroom (6) which has been updated from an ambulatory bedroom to a non-ambulatory bedroom with an approved fire clearance as of 7/10/2025. Bedroom 6 layout matches the facility sketch approved during the fire inspection. No deficiencies cited at this time. As a result of this visit, the facility is in compliance with Title 22 Regulations. An exit interview was conducted with Reign and a copy of the LIC 809 reports, were provided to the facility.the state’s words, verbatim · CDSS document, Jul 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Holly Williams and LPM Czarrina Camilon-Lee arrived unannounced to conduct an annual inspection. LPA Holly Williams and LPM Czarrina Camilon-Lee met with facility administrator Cynthia Mojica and explained the purpose of the visit. Licensing Program Analyst Holly Williams interviewed 4 staff files (S1-S4) and 5 resident files (R1-R5).LPA Williams and LPM Czarrina Camilon-Lee observed during record review that 3 out of the 4 file staff files did not have a personnel record. According to record review and observation resident R4 has a catheter and there is no care plan available to be reviewed in resident file. LPA Williams and LPM Camilon-Lee toured the facility with Mojica and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 71 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 120 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. The fence on the south west side of the backyard is falling over and Mojica was given a technical advisory for that. LPA Williams and LPM Camilon Lee observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Williams and LPM Camilon-Lee observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Williams and LPM Camilon-Lee observed a locked cabinet for the storage of medication. LPA Williams and LPM Camilon-Lee observed locked cabinets for the storage of cleaning solutions and knives. During the visit LPA Williams and LPM Camilon Lee observed medication was out on the counter and in a one day a week pill box for all residents. Continued 809-C LPA Williams and LPM Czarrina Camilon-Lee interviewed one staff (R2) and one resident (R2). This facility is being cited per 22 CCR section 87465(h)(2), 87609(a)(b)(4)(A), 87412(a). An exit interview was held with Mojica. Appeal rights and a copy of this report were given to Mojica.the state’s words, verbatim · CDSS document, Sep 26, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski spoke with facility administrator Cynthia Mojica over the phone and explained the purpose of the visit. Mojica said staff member Reign Balilo could sign this report in her absence. LPA Moleski reviewed an eviction notice sent by email to a resident's (R1's) responsible party. The notice, written by Mojica, was sent on February 20, 2024, and justified the eviction of R1 based on a "shortage of staff." The notice did not include a justification for eviction per 22 CCR Section 87224(a)(1-5), nor did it include specific facts to permit determination of the cause for eviction per 22 CCR Section 87224(d), nor did it include the components required per 22 CCR Section 87224(d)(1)(B-D). This facility is being cited per 22 CCR Section 87224(a). An exit interview was held with Mojica. Appeal rights and a copy of this report were left with Balilo.the state’s words, verbatim · CDSS document, Mar 14, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Mar 15, 2024

"The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5)." This requirement was not met as evidenced by: Based on record review, the licensee issued an eviction notice which did not specify what needs previously not identified R1 had developed, if and/or when a reappraisal was conducted to determine if R1's level of care was insufficient, and furthermore did not identify any other legitimate cause for eviction, which poses a potential health, safety, and/or personal rights risk.the state’s words, verbatim · CDSS document, Mar 14, 2024

Plan of correction: Licensee agrees to send a notice to R1's responsible party to rescind the eviction notice, and to copy LPA Moleski on the email. vincent.moleski@dss.ca.gov