Caring Partners II

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 was greeted and granted entry by Caregiver Joselito Gamas after introducing self and stating the reason for the visit. Administrator Arlene Fajardo arrived on premise to assist with the inspection. Administrator Fajardo has a valid certificate expiring June 18, 2027 per the Active Administrator Certificate List. The following was observed during the inspection: The facility is located in a residential neighborhood comprised of two private resident bedrooms, two shared resident bedrooms, two resident full bathrooms, and a shared staff bedroom. LPA observed six residents in care, three of which are on hospice. LPA observed two staff on duty. Facility is operating within the conditions and limitations specified on the license. LPA toured the physical plant. LPA inspected all common areas including the attached two car garage and all bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. Facility appeared clean, sanitary, and in good repair as well as all bathrooms. . Slip resistant mats were observed to be available in the bathrooms. The hot water temperature in the resident bathrooms measured within range at 112.2 and 116.4 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction, and there are sufficient seating and shading. LPA observed two secured gate exits that were operable. The first aid kit contains all necessary elements. The one fire extinguisher was mounted, charged, and serviced on April 20, 2026. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational in all areas. Facility maintains emergency food, water. and disaster supplies. A working telephone number (657) 301-2481 was tested and remains available. Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the entry way in the correct size. LPA reviewed six residents and two personnel files. No discrepancies noted. Present staff are background cleared and associated to the facility. Staff met their annual hours of training. The Emergency Disaster Plan (LIC610E) was reviewed. Disaster drills of various scenarios are conducted quarterly with the last date on March 18, 2026. Medications were audited for three of six residents. No discrepancies noted on administration and documentation. Based on the observations made during today's visit, no deficiency is being cited. An exit interview was conducted with Administrator Arlene Fajardo, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, May 29, 2026

Type of visit: Required - 1 Year

On May 14, 2025, at 8:00 AM, 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 was greeted and granted entry by Caregiver (CG) Virgilio Herrera. Administrator (AD) Arlene Fajardo arrived at the facility around 8:15 AM and LPA Kim explained the purpose of the visit. The facility is licensed to operate for six (6) nonambulatory residents, and has a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, dining area, kitchen, shaded table with chairs in the backyard, and an attached two car garage. LPA Kim toured inside and outside of the physical plant with ADMIN Fajardo. There were no bodies of water or obstructions in the facility. 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, and Resident Room 4. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 114.1 degrees F to 114.3 degrees F. A comfortable temperature of 71 degrees F was maintained in the facility. LPA Kim observed the facility to be 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. Evaluation Report Continues on LIC 809-C 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). Emergency food, emergency water, and emergency supplies are stored in the garage. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. The facility has one (1) fire extinguisher that is charged and mounted in the kitchen, and was last inspected on May 9, 2025. All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable. A working telephone (657-301-2481) and video teleconferencing tablet dedicated to the residents both remain available. Last emergency drill was conducted on March 20, 2025. First aid kit is maintained and contains all the necessary elements. Evidence of Liability is effective July 1, 2024, and expires July 1, 2025. LPA Kim conducted an audit of resident files (R1-R6), staff files (S1-S5), and medication and medication administration record. Appraisals for R1, R2, and R3 were dated from May 14, 2023. S1 did not have a valid TB test in their record. LPA Kim conducted two (2) resident interviews. Deficiencies were cited during this visit per Title 22 Division 6 Chapter 8. LPA observed R1, R2, and R3 had their reappraisals last done on May 14, 2023, and S1 did not have valid TB test in their record. An exit interview was conducted, and a copy of this report and appeal rights were provided to Administrator Arlene Fajardo.the state’s words, verbatim · CDSS document, May 14, 2025

Type of visit: Required - 1 Year

On 8/12/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA was greeted and granted entry by Caregiver, Daisy Moscono who was informed of the purpose of LPA's visit. Licensee, Arlene Fajardo arrived during the visit and was also informed of the purpose of the visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents and an approved hospice waiver for four (4). LPA was informed three (3) residents are currently receiving hospice services at the facility. During today's visit, there was four (4) residents and two (2) staff present. LPA toured the facility with Licensee, Arlene Fajardo and observed the facility is made up of a one-story home with four (4) resident bedrooms, two (2) bathrooms, one (1) staff room, a kitchen, dining room, living room, and attached garage. During the tour, Caregiver, Virgilio Herrera tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted near the kitchen, last serviced on 3/18/2024. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the residents in care. The facility also has emergency food, water, incontinent supplies, cleaning solutions, disinfectants and the laundry service stored in the garage. There were no bodies of water observed on the premises. Medications are secured in a locked kitchen cabinet. Resident bedroom had the required furniture and lighting. Bathrooms had grab bars near the toilet and in the showers. LPA observed a cabinet filled with clean linens and towels. LPA toured the kitchen and observed the facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Resident files reviewed had signed admission agreements and updated physician reports. Staff present have a criminal record clearance and valid first aid/CPR certification. Complaint procedures, facility sketch, resident rights, Long Term Care Ombudsman and emergency contact information are visibly posted throughout the facility. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where this report was reviewed and provided to Licensee Fajardo.the state’s words, verbatim · CDSS document, Aug 12, 2024