Care Celine

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced annual inspection of the facility. Upon arrival, LPA Haddadin was greeted by Administrator Cherry Aguila, who granted entry into the facility. The facility is a two-story building located in a residential neighborhood. The facility consists of five resident bedrooms, two staff bedrooms, three bathrooms, a living area, dining area, kitchen, outdoor covered patio area, and an attached two-car garage. During the inspection, LPA Haddadin toured the interior and exterior areas of the facility to evaluate compliance with applicable health and safety requirements. All smoke detectors were tested and found to be operational. The hot water temperatures measured in all three bathrooms ranged from 114.1 to 116.9 degrees Fahrenheit. The auditory devices installed on all facility exits were tested and found to be operational. Residents’ bedrooms contained the required furniture and bedding supplies. Adequate closet and drawer space was available for residents’ personal belongings. An evacuation chair was observed on the second floor. The fire extinguisher was fully charged and had a documented inspection date of September 19, 2025. The exterior area was inspected. The facility had a shaded seating area and ample space for residents’ activities. No obstacles were observed. The facility maintained an adequate food supply consisting of at least two days of perishable foods and seven days of nonperishable foods. Knives, cleaning supplies, and other potentially hazardous items were secured in a locked kitchen cabinet and inaccessible to residents. LPA Haddadin inspected the medication storage area and first-aid kit. {CONTINUE 809C} The first-aid kit contained all required components. Medications were secured and locked. LPA Haddadin reviewed two staff records and two resident records. All required documentation was complete and up to date. The facility’s most recent emergency drill was conducted on August 25, 2026. Based on observations made and records reviewed during today’s inspection, no deficiencies are being cited pursuant to Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted with Administrator Cherry Aguila, and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 16, 2026

Type of visit: Required - 1 Year

On September 29, 2025, at 1:45 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Cherry Aguila and explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents and has a hospice waiver for six (6) residents. The facility is a two-story building located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) staff bedrooms, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio area, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Aguila. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found clean and operational. The water temperature measured 121.6 degrees F to 129.3 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the garage. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (714) 340-0754 remains available. First Aid kit had all the necessary elements. The facility has two (2) fire extinguishers that were charged, mounted in the living area and on the second floor next to the staff room that were serviced on September 4, 2025. Emergency drills are conducted quarterly and were last conducted on August 20, 2025. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S3), and a medication and medication administration record that were all in order and complete. LPA Kim conducted interviews with one (1) staff and two (2) residents. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA observed hot water temperature in shared resident bathroom measured at 121.6 degrees F and resident room #1 bathroom measured at 129.3 degrees F An exit interview was conducted, and a copy of this report, LIC811, and appeal rights were provided to Administrator Cherry Aguila.the state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: POC

Licensing Program Analyst (LPAs) Jessica Cho and William Vanegas made an unannounced visit for the purpose of clearing the deficiencies cited during an annual inspection conducted on September 9, 2024 from 7:00am - 2:45pm. Deficiency cited under Title 22 Regulations 87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). ---- Locking mechanisms were repaired during the visit on September 9, 2024. Deficiency cited under Title 22 Regulation 1569.618 Other Provisions (c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.---- Cleared Deficiency cited under Title 22 Regulation 87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.--- Cleared Deficiency cited under Title 22 Regulation 1569.69 Other Provisions (e) Each person who provides employee training under this section shall meet the following education and experience requirements: (3) The licensed residential care facility for the elderly shall maintain the following documentation on each person who provides employee training under this section: ---- Cleared Deficiency cited under Title 22 Regulation 87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations.--- Cleared Deficiency cited under Title 22 Regulation 87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment.---- Cleared Deficiency cited under Title 22 Regulation 87458 Medical Assessment (b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility.---- Cleared Deficiency cited under Title 22 Regulation 1569.695 Other Provisions (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill --- Cleared Deficiency cited under Title 22 Regulation 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs.---- Cleared Technical Violations pertaining to posting of No-Smoking signs and replacing batteries --- Cleared Technical Assistance pertaining to labeling pantry items. --- Cleared All deficiencies and Technical Advisories have been cleared. An exit interview was conducted with Administrator Cherry Aguila, and a copy of this report and the Letter of Deficiencies Citations Cleared were provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 1, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA met with Administrator Cherry Aguila and explained the reason for the visit. Facility is licensed to serve six (6) non-ambulatory residents and maintains an approved hospice waiver for six (6) residents. There are four (4) residents in care during today's visit with two caregivers on duty. The Administrator's Certificate for Cherry Aguila expires on November 11, 2024. LPA conducted a tour of the physical plant. This is a two story home in a residential neighborhood. The first floor consists of five resident bedrooms and two resident bathrooms. The second floor consists of two bedrooms and one bathroom which is occupied by one live-in staff. The second bedroom and bathroom is unoccupied. Residents do not occupy the second floor. LPA inspected all common areas including the attached two car garage. LPA observed the floor, bathrooms, and kitchen drawers require a deep cleaning. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be operational. The water temperature measured at 108.0 and 110.0 degrees Fahrenheit. Toxins, disinfectants, and medications were secured and inaccessible, however the sharps were unsecured in the oven as the locking mechanism for the knife drawer was not working properly at the time of inspection. Locking mechanism was repaired during the visit. LPA observed sufficient two day supply of perishables and seven day supply of non-perishable food. LPA toured the exterior portion of the facility. LPA observed the outdoor passageway free of obstruction. LPA observed sufficient seating and shading. There was no body of water. Several sheds in the yard were utilized as storage which were secured and inaccessible to residents. Facility maintains two fire extinguishers one on each floor. Last service date was on September 19, 2023. The auditory devices and smoke/carbon monoxide detectors were tested and operational except for one auditory device on the sliding door. LPA observed sufficient PPE and emergency disaster supplies including food/water in the garage. Emergency evacuation drills are not conducted quarterly and facility does not maintain a log documenting the drills. The first aid kit contains all necessary elements. LPA observed the required 'See Something, Say Something' (PUB475) poster in the correct size. Facility maintains a current liability insurance. A working facility telephone number, (714) 340-0754, remains available. The annual licensing fee of $495.00 was paid on September 8, 2024. LPA conducted an audit of four residents' files and two personnel files. Discrepancies were noted. Medications were audited for four residents. No discrepancies noted. Staff and resident interviews were also conducted. The following items were consulted with Administrator Aguila: to replace battery for one auditory device on the sliding door, label expiration dates for all dried food items, deep clean the pantry drawers, bathrooms, and the floor for both levels, repair the light in the stairway that was flickering, post "Oxygen In Use, No Smoking signs for one bedroom and on the main door, complete/organize resident/personnel records, ensure staff training records are completed and maintained, to ensure at least one on duty staff is CPR/First Aid certified, to conduct quarterly evacuation drills, and to maintain a log. Based on the observations made during today's visit, deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC9099-Ds. Advisory Notes are also being issued. An exit interview was conducted with Administrator Cherry Aguila and a copy of this report including the LIC9099-C & Ds, Advisories, and the Appeal Rights were sent via email at the end of the visit.the state’s words, verbatim · CDSS document, Sep 9, 2024

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.