Casa Zagara Inc.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit to the facility to perform a health and safety check. Upon arrival, LPA met with Caregiver Ruben Yamuta and explained the purpose of the visit. During the visit, LPA toured the facility, and talked to residents . No immediate health or safety concerns were observed at the time of the visit. An exit interview was conducted, and a copy of this report was provided to Caregiver Ruben Yamutathe state’s words, verbatim · CDSS document, Jul 28, 2026

Type of visit: Case Management - Deficiencies

This Case management– Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Abdoulaye Zerbo for the purpose of issuing citations for deficiencies observed during the visit on 03-26-26. LPA met with Caregiver Ruben Yamuta and explained purpose of the visit. During the visit, LPA reviewed R1 records and noticed R1's file was incomplete. Based on record review and interviews, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted, and a copy of this report and appeal rights was discussed with and provided to Caregiver Ruben Yamuta.the state’s words, verbatim · CDSS document, Mar 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Apr 24, 2026

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above. R1's records were incomplete and did not meet the requirements per title 22the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Licensee stated they will complete all the records per title 22 and submit proof of completion to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Licensees Jesse Madera and John Prevel who were informed of the purpose of the visit. At the time of the visit there was (4) staff and (4) residents present. The facility is a one story home with (4) bedrooms and (3) bathrooms for residents. No pools or firearms are being kept at the facility. LPA observed the following: Physical Plant: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents in pantry closet. The smoke detector and carbon monoxide was operational, and the hot water temperature 115F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. The current administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed (3) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. (4) resident files were reviewed, and possessed all required paperwork. Technical note was documented for Resident whose LIC602 reflects a bedridden status, when based on observation and interview the resident is able to reposition themselves in bed. Recommendation was made for licensee to obtain an accurate LIC602 to reflect ambulatory status for the resident. Health Related Services/ Incidental Medical Services: All resident medication was locked in closet. LPA reviewed resident medications for (4) residents and found all medication listed on MARS and accounted for. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire drill 12/2/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.the state’s words, verbatim · CDSS document, Dec 16, 2024

Allegation investigated: Staff not keeping facility free from pests.

Licensing Program Analyst, (LPA) Jacqueline Shaw Ross conducted an unannounced visit to deliver findings on the above allegation. LPA met with Leslie Minchello, Caregiver/Admin Assistantwho was informed of the purpose of the visit. During the investigation, LPA interviewed staff and residents, conducted an inspection of the facility, and reviewed facility records. LPA was unable to interview two out of the three residents due to one of the residents passing away and the other resident was unable to communicate. On 5/17/2024, Community Care Licensing received a complaint investigation stating that staff are not keeping the facility free from pests. Information obtained from staff interviews indicated that the facility has been experiencing bugs, particularly "roly poly bugs," that were on and around the exterior doors and in the garage. Licensees also stated staff reported seeing one mouse under the kitchen sink in April of 2024. Licensees indicated they took preventive measures by contacting a pest control service immediately after the issue was brought to their attention. Documents obtained revealed that in November 2023, while the home was vacant, a service by the pest control was completed. It was advised that due to observing pests, the service was reinstated in April 2024. Licensees signed an annual contract in April for the facility to be serviced monthly and there have been no evidence of bugs since then. Unsubstantiated LPA interviewed one out of three residents who reported they have not seen any bugs or insects since their arrival. Resident indicated there were no issues or concerns regarding the facility. LPA conducted an inspection of the facility and did not observe any mice, but did observe roly polies on the doorframes, windowsills, and in the garage. Based on interviews with staff and residents, review of facility documents, and inspection of the facility, there is not enough evidence to support the allegation that staff is not keeping facility free of pest. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Leslie Minchello, Caregiver/Administrative Assistant.the state’s words, verbatim · CDSS document, Jun 6, 2024 · control 18-AS-20240517110825

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Janira Arreola conducted an announced visit to the home in order to conduct an initial pre-licensing inspection. LPA met with applicants: John Prevel, Jesse Madera and Administrator Bridgett Genske Dokken. LPA conducted a walk through and reviewed the pre-licensing documents. The facility will serve elderly ages 60 and above. The fire clearance was approved from bedridden in Bedroom #1 and #4. The home is licensed for capacity of (6), (5) non-ambulatory, (1) of which may be bedridden. The home is a one story home with attached garage, with (5) bedrooms, 1 staff office, (1) caregiver room and (2.5) bathrooms. No pools are present at the facility. LPA observed PPE equipment and hand washing stations in the facility. LPA observed the emergency supplies and emergency exits. The physical plant was observed to be in good repair and free of hazards. The bedrooms had the required furniture along with linens. The facility kitchen can prepare food in a clean and safe environment. The facility possessed requirement amount of emergency supplies. The smoke alarms were tested and observed to be operational. There are designated locked areas for resident medication and sharps hazardous objects. The hot water temperature was recorded in resident restroom at 115F, and the land line was operational at (760) 298-1489. There are no objections for the applicant to proceed in the pre-licensing process. An exit interview was conducted with Jesse Madera where this report ad provided to them.the state’s words, verbatim · CDSS document, Dec 8, 2023