Caring Heart II

Type of visit: Required - 1 Year

On 05/27/2026 at 2:00 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with the facility designated administrator Kristine. The current census is 6 with 1 facility staff present. This facility is a single story building licensed to serve (6) non-ambulatory residents. LPA 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 observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 115.3 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat 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 entry way and was last serviced on 05/21/2026. LPA observed the facility has a public telephone in the kitchen area and the facility has the required posters posted. Facility thermostat was observed at 70 degrees Fahrenheit. LPA observed toxins located in the hallway closet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 3 out of 6 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 6 out of 6 resident files and they were complete. LPA reviewed 3 staff files, and it was complete. LPA 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. The following documents will be email to LPA by 05/29/2026 (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, and a copy of the LIC 809 report was provided to the facility.the state’s words, verbatim · CDSS document, May 27, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced. To deliver ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES. S1 was not present at the time of this visit and was not on the Personnel Report dated 04/18/2025. Facility understands this is an Immediate Exclusion effective today. S1 is excluded and prohibited from being a licensee, owning a beneficial ownership of 10% interest or more in a licensed facility, or being an Administrator, officer, director, member, or manager of a licensee or entity controlling a licensee. S1 cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed and cited. Exit interview held, Copy of report giventhe state’s words, verbatim · CDSS document, Nov 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Jenny Duran and explained the purpose of the visit. LPA Moleski reviewed three resident files (R1-R3) and three staff files (S1-S3). LPA Moleski toured the facility with Duran 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 72 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. LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives. LPA Moleski interviewed one staff member (S2) and one resident (R4). No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Duran.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Vincent Moleski and Holly Williams arrived unannounced to conduct a case management visit. LPAs Moleski and Williams spoke with Edward Aducayen over the phone and explained the purpose of the visit. Aducayen said that staff member Remedios Templo could sign this report in his absence. This facility received an updated fire clearance after an inspection on 7/24/24. LPA Moleski printed and signed an updated license for this facility, reflecting the new fire clearance provisions. LPA Moleski retrieved this facility's old license. No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Templo.the state’s words, verbatim · CDSS document, Sep 12, 2024

Type of visit: Prelicensing

On 06/10/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived announced to conduct a Pre-Licensing Visit. LPA Pascua was greeted by applicant, Kristine Aducayen and explained the purpose of the visit. The purpose of this visit was to conduct a Change of Ownership Pre-Licensing Visit. Current census was 6. A brief interview with Applicant Aducayen was conducted. This facility current holds 6 residents, of which 1 may be bedridden located in Bedroom #1. 5 out 6 residents may be non-ambulatory. This facility also holds a dementia plan and has a hospice waiver for 6. A tour of the facility was conducted. Smoke detectors and carbon monoxide was observed to be in good repair. LPA toured the office area which holds, resident, staff and medication. LPA reviewed 2 staff files and 2 resident files. Along with the applicant, the LPA reviewed, discussed and compared medication to medication dispensing logs. First aid kit was present and in compliance. The facility administrator holds a current certificate #6020119740 and expires on 09/08/2024. LPA toured the living room. dining room, and all other areas intended for resident use. Furniture and furnishings were in good repair. LPA toured the kitchen. LPA observed knives and sharps locked and made inaccessible. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply. Fire extinguisher was observed to be last serviced on 03/09/2024 by River City Fire Equipment Company. LPA toured the outside area. Perimeter fence and gates were observed to be in good repair with no hazards present. Exit gate was observed and was in good repair. LPA toured 2 resident bathrooms. Hot water temperature was taken to ensure compliance within 105-120 degrees. LPA observed grab bars present in both bathrooms. LPA toured 6 resident bedrooms. Furniture and furnishings were observed to be sufficient to meet resident needs and were in good repair. Washer and dryer were identified in the hallway. Laundry detergent, cleaning supplies and other toxins were locked and made inaccessible. LPA also identified additional linens in a cabinets adjacent to the washer and dryer. This facility has been observed to be in compliance at this time. There were no deficiencies observed during the course of this Pre-licensing visit. Applicant has already conducted Comp I and Comp II. Comp III was reviewed with applicant. Exit Interview was conducted and a copy of this report was provided to the applicant at the end of the visit.the state’s words, verbatim · CDSS document, Jun 10, 2024