Care Marstel 1

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Shirley Natividad and Licensee (LE) Minelli Martinez and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 10:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 4-bedroom, 3-bathroom, two-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 4 residents present at the facility in addition to AD. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 111 degrees F in the common resident bathroom. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 8:00AM, LPA reviewed 4 resident files and 3 staff files, interviewed 2 residents and 2 staff, and inspected medications for 4 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on documents, the facility does not have doctor's orders for R3's multivitamin, loratadine, and DGL licorice, and R4's calcium and astaxanthin; and based on documents, the physician's report for R1 is on the old form and the physician's report for R3 is on the incorrect form, and neither contains required information, including behavioral expressions. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jun 15, 2026

Type of visit: POC

This unannounced POC inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of verifying correction of deficiencies issued during the Required – 1 Year Inspection conducted on July 8, 2024. LPA met with Staff #1 (S1) Shirley Natividad and discussed the purpose of the inspection. During the inspection, LPA and S1 toured the facility and observed the following: Type A Violation cited under California Code of Regulations (CCR) Title 22, Section 87202(a) pertaining to a fire clearance violation has been CLEARED. Previously, LPA had noted that the facility's fire clearance shows one large staff bedroom on the second floor but the bedroom had been divided into four staff bedrooms without obtaining a new fire clearance. During today’s inspection, LPA inspected the second floor and observed that there is one large bedroom and the physical layout now matches the fire clearance. S1 stated that the facility is still considering alterations to the second floor, but will ensure that all changes are properly permitted and will notify LPA of any planned construction before it takes place and will work with LPA to obtain a new fire clearance once any construction has been completed. There were no deficiencies observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Sep 8, 2025

Type of visit: Required - 1 Year

the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Shirley Natividad and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 8:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 7-bedroom, 3-bathroom, two-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 3 staff and 4 residents present at the facility in addition to AD. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 3 staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 105 degrees F in the 2 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:00AM, LPA reviewed 4 resident files and 4 staff files, interviewed 2 residents and 2 staff, and inspected medications for 4 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on documents, the facility has not been maintaining emergency disaster logs documenting emergency disaster drills conducted. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jul 10, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff did not prevent resident from self-harming Resident had access to sharp object.

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA was granted access into the facility, identified herself, and met with Caregivers Romelito Pascual, Reynerio Dagatan and Genesis Valencia. Administrator Shirley Natividad arrived shortly after and purpose of the visit was discussed. LPA conducted the initial investigation visit on 10/10/2024. LPA conducted interviews, made observations, and obtained and reviewed pertinent records such as Physician’s Report dated 7/28/2023, Register of Residents dated 7/1/2024, Appraisal/Needs and Services Plan dated 8/1/2023, and La Habra Police Report #24-032158. First allegation: It was alleged that staff did not prevent resident from self-harming. On 09/30/2024, Resident 1 (R1) was found with two neck lacerations to the neck and three right wrist lacerations. (cont...LIC9099C) Substantiated Interviews revealed that R1 was upset and worried that R1 was not going to get pain medication (Norco tablet 10-325 mg) because R1 had been discharged from Hospice on 9/18/2024 and would only have the Norco until 9/29/2024. R1’s last dosage of the Norco was on 09/29/2024 at 06:00am. Interviews also revealed that facility was aware that R1 had a history of suicide attempts. R1’s Medical records from Post Acute dated 08/01/2023 shows “Suicide Attempt” and Physician’s Report dated 7/28/2023, R1 shows “Suicidal/Self-Abuse.” Review of R1’s Appraisal/Needs and Services Plan does not show that facility, knowing R1’s history of “suicidal ideation” had a plan in place to prevent R1 from harming self. Even though R1’s Physician Report dated 7/28/2023, confirms R1 is “At Risk if Allowed Direct Access to Personal Grooming and Hygiene Items” Staff still provided R1 with a razor without supervision and staff failed to take the razor back once R1 was done with it. Second allegation: It was alleged that Resident had access to sharp object. During the investigation visit, LPA toured the facility and observed all sharps, such as knives, scissors, razors, etc. were locked away and made inaccessible to the residents present. Interviews revealed R1 would receive razors through Amazon that R1’s son would purchase and have delivered to the facility. Razor’s would be placed in a locked cabinet in the garage. Interviews revealed that when R1 needed a razor staff would just hand R1 a razor to use. Staff would not monitor or request the razor back; just assumed R1 would toss it out. Per R1’s Physician Report dated 7/28/2023, R1 is “At Risk if Allowed Direct Access to Personal Grooming and Hygiene Items.” Based on the information gathered the preponderance of evidence standard has been met, therefore, the allegations, that staff did not prevent resident from self-harming and Resident had access to sharp object are found to be Substantiated. Violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report along with citation and Appeal Rights was sent to email on file.the state’s words, verbatim · CDSS document, Nov 4, 2024 · control 22-AS-20241004120407

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Nov 5, 2024

Basic Services. Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). "Care and Supervision means the facility assumes responsibility for, or provides or promises to provide the future, ongoing assistance with activities of daily living without which the resident's physical health, mental health, safety or welfare would be endangered. This requirement was not met as evidenced by: Based on interviews and records reviewed, facility failed to provide adequate care and supervision to R1 who had a history of suicidal ideation...the state’s words, verbatim · CDSS document, Nov 4, 2024

Plan of correction: Licensee to conduct in-service training with all staff on section cited and submit proof to CCL by 11/08/2024 Facility had knowledge of R1’s history of suicidal attempts yet was handed razors to use without supervision, which poses an immediate health and safety risk to persons in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Nov 5, 2024

Storage Space - (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to Residents shall be stored where inaccessible to Residents. This requirement was not met as evidenced by: Based on interviews and records reviewed, facility staff would hand R1 a razor and failed to take the razor back from R1 making it accessible, which poses an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, Nov 4, 2024

Plan of correction: Licensee to conduct in-service training with all staff on section cited and submit proof to CCL by 11/08/2024

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Shirley Natividad and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 9:30AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 7-bedroom, 3-bathroom, two-story house with attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA and AD observed 3 staff and 6 residents present at the facility. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 4 staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 105 degrees F in the common resident bathroom and 109.7 degrees in the private resident bathroom. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 8:00AM, LPA reviewed 6 resident files and 3 staff files, interviewed 3 residents and 2 staff, and inspected medications for 6 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on observation and admission, the facility's fire clearance shows one large staff bedroom on the second floor but the facility divided the bedroom into four staff bedrooms without obtaining a new fire clearance; based on observation, the facility does not have the personal rights posted; based on documents, the licensee did not ensure the medications of 6 out of 6 residents were tracked by not using a Medication Administration Record (MAR); and based on observation and admission, the facility has two stories with only staff living upstairs but does not have an evacuation chair Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Jul 8, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.