Carnation's Home

Type of visit: Required - 1 Year

On 9/29/2026 at 9:00 AM, Licensing Program Analyst (LPA) Matthew Aguilar made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Sophia Ramirez and was granted entry to the facility. At the time of the visit there were three (3) staff present, and six (6) residents present. The facility has four (4) bedrooms, two (2) bathrooms with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for six (6) non ambulatory residents, of which one (1) may be bedridden in bedroom four (4). The facility has two (2) hospice care waivers and the current census is six (6) residents. The facility is also licensed to care for residents with dementia. LPA was accompanied by a staff to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom to be at 110 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguisher was also observed at the facility. Posters such as personal rights, the CCLD complaint poster, and the disaster plan were posted in a common area. ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine closet with the resident’s medications locked. LPAs observed first aid kit and first aid book at the facility. Yards/Outside: One shaded patio with a wheelchair ramp, one (1) side gate with self-latching handles on the right side of the house that leads into the backyard, and an attached two (2) car garage observed. All outdoor pathways were free of obstructions. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. LPA observed that the facility has sufficient 72 hour emergency food and water. Care & Supervision: The facility has an Administrator present in the facility with enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed resident files reviewed were complete. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed staff files are complete. LPA observed that the facility completed quarterly fire and earthquake drills. LPA conducted a medication audit and reviewed three (3) resident medications. LPA observed that 2 out of 3 residents’ medication were missing documentation of administered medication. Administrator Ramirez stated that they administered the medication but they forgot to document it on the MAR. LPA counted the medication and observed that the medication administered matched the MAR. LPA also interviewed one (1) resident regarding administered medication. Resident #1 (R1) stated that they always receive their medication on time. A deficiency will be cited. Based on the observations made during today’s visit, one deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809 and LIC809D was discussed and provided to Administrator Sophia Ramirez.the state’s words, verbatim · CDSS document, Sep 29, 2026

Type of visit: Post Licensing

On 06/29/2026 at 1.00 PM, Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for purpose of Post-licensing visit. LPA met with Administrator/Applicant Sophia Ramirez. There were three(3) residents present at the facility and one(1) was out in the community. LPA Singh observed the following: Facility is a one (1) story house with four (4) client bedrooms and a staff office and two (2) bathrooms, living room, dining area and kitchen. There was a two (2) car garage attached in the right side of the house. Central heating and air conditioning system installed with one (1) central panel located in the hallway to control the entire house. The facility is at comfortable temperature of 76 degrees Fahrenheit. Each bedrooms accommodate any ambulatory residents and one bedroom for bedridden resident. All residents bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. The two (2) bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. Water temperature in the resident's bathrooms, was within regulations. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. There is sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies were observed in the garage in a locked cabinet. Garage door is locked away from residents. There was a living/family room with adequate seating for all residents and a working TV. An adequate supply of linens was stored in a cabinet in the hallway of the residence. Patio furniture for outdoor seating observed. Self-latching handle gate on left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Facility sketch was observed posted near the main entrance. There was Let-Us-No poster and Labor Laws observed. One (1) fire extinguisher was charged and located in the kitchen area. Three (3) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Residents records and staff records are stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed in the kitchen cabinet. There is enough Emergency water supply and the required 72-hour emergency food supply for clients and staffs available at the facility. Liability Insurance is valid through 10/20/2025 to 10/20/2026. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Licensee/Administrator- Sophia Ramirez.the state’s words, verbatim · CDSS document, Jun 29, 2026

Type of visit: Prelicensing

On 09/15/2025 at 09:00 AM, Licensing Program Analyst (LPA) Beena Singh conducted an announced visit to the facility for purpose of Pre-licensing evaluation. LPA met with Administrator/Applicant Sophia Ramirez. An initial application to operate RCFE was submitted to the Central Applications Bureau (CAB) on 10/01/2024 for a total capacity of five (5) Ambulatory and one (1) bedridden. Fire clearance was granted on 11/06/24. LPA Singh observed the following: Structure: Facility is a one (1) story house with four (4) client bedrooms and a staff office and two (2) bathrooms, living room, dining area and kitchen. There was a two (2) car garage attached in the right side of the house. Heating/Cooling System: Central heating and air conditioning system installed with one (1) central panel located in the hallway to control the entire house. The facility is at comfortable temperature of 76 degrees Fahrenheit. Bedrooms: Each client bedrooms accommodate any ambulatory residents and one bedroom for bedridden resident. All residents bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, a lamp and an operable smoke/carbon monoxide alarm. Bathrooms: The two (2) bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. LPA tested the water temperatures in the clients' bathrooms. LPA Singh verified water temperature was measured at 117 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA Singh observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was in the laundry room. Laundry detergents and cleaning supplies were observed in the garage in a locked cabinet. Garage door is locked away from residents. Living/Family room: There was a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle gate on left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch was observed posted near the main entrance. There was Let-Us-No poster and Labor Laws observed. General items: One (1) fire extinguisher was charged and located in the kitchen area. Three (3) combined smoke detectors and carbon monoxide detectors were tested and were observed to be in working order. Client records and staff records will be stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed in the kitchen cabinet.. LPA Singh observed a facility phone and phone number designated for the facility is 909-460-9114. There is enough Emergency water supply and the required 72-hour emergency food supply for clients and staffs available at the facility. Additionally, LPA Singh observed facility having Visitor Sign In/Sign Out Sheet and Client Sign In/Sign Out Sheet, upon entering facility. Pre-Licensing and Comp III were completed at the same time during this visit. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report, LIC809 was discussed and provided to Applicant/Administrator Licensee/Administrator- Sophia Ramirez.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Sophia Ramirez, CEO/Administrator Interview Method: Telephone interview On 9/3/25, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Sep 3, 2025