Casa Trinidad

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Gina Agustin and advised her of the purpose for the visit. At approximately 10:30am, LPA took a tour of the physical plant. The facility is a one (1) story building. There is an exterior fence/gate in the front yard that is only locked from the outside. Gate/door is single action. It unlocks and opens from inside the compound when exiting. The smoke alarms and the carbon monoxide detectors are dual and interconnected. The fire extinguisher is located in the living room It was purchased on 04/29/26. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, sealed and properly stored. Knives were stored in a locked drawer. No cleaning supplies or cleaning agents observed out during the day's inspection. Bedrooms: There are four (4) bedrooms. Three (3) are designated for client use. Bedroom #1 is private. Bedrooms #2 and #3 are shared rooms. One bedridden resident can be placed in either bedroom #1 or #2 (per STD 850). Bedroom #4 is reserved for staff. Rooms designated for resident use were properly furnished with sufficient lighting and closet space. Bathrooms: The facility has three (3) bathrooms. Bedroom #3 has it's own bathroom with shower. The other bathroom is located in the hallway, outside of bedroom #3. The third bathroom, is designated for staff. It is located by the kitchen. The bathrooms, designated for resident use were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 111 and 112 degrees. Common Areas: These included the living room and dining area. The living room has a sufficient seating of a couch, bookshelf, and coffee table. The dining room table is large enough to seat six (6) residents. LPA observed furniture to be maintained and in good repair. The floors were mopped and clean. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Passageways and entrance were clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. Backyard has sufficient yard space to hold activities. There is storage space in the back that is kept locked. There is no swimming pool or bodies of water. Laundry Area: The laundry area, where detergents and cleaning supplies are kept locked, is located by the kitchen. Garage: Facility has an enclosed garage attached to the home. It is used for storage. Work Station/Office: Staff office where medications, staff and resident records are maintained, is located by the living room. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure compliance with licensing forms. Medications: Medication cabinet is maintained in the staff office. Medication and Medication Records were reviewed for proper storage and documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, May 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Gina Agustin and advised her of the purpose for the visit. At approximately 12:00pm, LPA took a tour of the physical plant. The facility is a one (1) story building. There is an exterior fence/gate in the front yard that is only locked from the outside. Gate/door is single action. It unlocks and opens from inside the compound when exiting. The smoke alarms and the carbon monoxide detectors are dual and interconnected. The fire extinguisher is located in the living room It was purchased on 05/01/24. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, sealed and properly stored. Knives were stored in a locked drawer. No cleaning supplies or cleaning agents observed out during the day's inspection. Bedrooms: There are four (4) bedrooms. Three (3) are designated for client use. Bedroom #1 is private. Bedrooms #2 and #3 are shared rooms. One bedridden resident can be placed in either bedroom #1 or #2 (per STD 850). Bedroom #4 is reserved for staff. Rooms designated for resident use were furnished with beds, night stand, chairs, dresser, bedding and linen. Resident bedrooms have sufficient lighting and closet space. Bathrooms: The facility has three (3) bathrooms. Bedroom #3 has it's own bathroom with shower. The other bathroom is located in the hallway, outside of bedroom #3. The third bathroom, is designated for staff. It is located by the kitchen. The bathrooms, designated for resident use were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 120 degrees. Common Areas: These included the living room and dining area. The living room has a couch, bookshelf, side and coffee table. The dining room table is large enough to seat six (6) residents. LPA observed furniture to be maintained and in good repair. The floors were mopped and clean. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Passageways and entrance were clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space to hold activities. There is storage space in the back that is kept locked. There is no swimming pool or bodies of water. Laundry Area: The laundry area, where detergents and cleaning supplies are kept locked, is located by the kitchen. Garage: Facility has an enclosed garage attached to the home. It is used for storage. Work Station/Office: Staff office where medications, staff and resident records are maintained, is located by the living room. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure training documents and licensing forms are in compliance. Medications: Medication cabinet is maintained in the staff office. Medication and Medication Records were reviewed for proper storage and documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Apr 30, 2025

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Raymond Comer and Michael Cava conducted a Pre-Licensing Inspection with the applicant/administrator, Gina Agustin and her consultant, Jason Dy. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on August 7, 2023. A fire clearance was approved on January 10, 2024 for two (2) ambulatoty, three (3) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six. The applicant will be requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are hard wired and inter-connected. The facility has two new fire extinguishers that was purchased in November 2023. One fire extinguisher is located in the living room, and the other in the garage. A tour of the physical plant was initiated at approximately 12:23pm and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There was an adequate supply of nonperishable food and dining ware to accommodate a maximum capacity of six (6). Perishable food not needed at this time as currently there are no residents. Knives will be locked in a kitchen drawer. BEDROOMS: There are four (4) bedrooms. Three (3) are designated for client use. Bedroom #1 is private. Bedrooms #2 and #3 are shared rooms. One bedridden resident can be placed in either bedroom #1 or #2 (per STD 850). Bedroom #4 is reserved for staff. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has three (3) bathrooms. Bedroom #1 and #3 has it's own bathroom with shower. The other bathroom is located at the hallway. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 120 degrees. COMMON AREAS: These included living room and dining room area. Furniture and floors were clean and in good repair. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards. LAUNDRY ROOM: The laundry room is located in the kitchen. It was observed with a locked door to make it inaccessible to the residents. The washer/dryer are brand new. Detergents and cleaning supplies are kept and maintained in the laundry room. MEDICATIONS: Medications will be kept, locked and stored in the office/workstation. OFFICE/STAFF WORKSTATION: Staff workstation is located by the living room. Resident and personnel files will be maintained in a locked filing cabinet there, alongside the medications. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio and backyard furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or bodies of water. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 12, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Census (if any clients in care): N/A Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Feb 16, 2024