Cassandra's Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow arrived unannounced to conduct the required annual visit to the facility. LPA met with Caregiver, Cintia Espinoza Lopez, and introduced self and stated purpose of the visit. Cintia notified the Administrator and House Manager of LPA's arrival. LPA was informed that there are currently 4 residents the home. The facility has 4 resident bedrooms, 1 staff room/ office, 2 bathrooms, kitchen, dining area, living room, attached garage, backyard with 2 shaded/cover areas. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 116.3 and 117.9 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, 3 fire extinguishers and emergency kit. Posters such as; the personal rights, ombudsman and emergency disaster plans were posted in a common area. LPA observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed in a secured filing cabinet and inaccessible to residents. There are no firearms, ammunition, swimming pool or bodies of water. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed that one (1) out of two (2) was missing a current physician report. A deficiency cited. LPA requested three staff for review for First Aid/CPR certifications, criminal record clearances, training's, and health screenings. LPA observed all staff files were complete and in order. LPA observed the facility file for Infection Control Plan, Emergency Disaster Plan, Liability Insurance, and Fire drills. LPA observed the Infection Control Plan was missing a signature stating it was signed, updated, and or reviewed for 2025. A technical violation issued. Also, the Liability Insurance was not updated and available for review. A deficiency cited. LPA conducted a random audit of two (2) residents medication. LPA observed that one (1) out of two (2) residents was missing initial for medications that was dispensed on the 16th and 17th of November. A deficiency cited. During todays visit three (3) deficiencies and one (1) technical violation were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and LIC9102TV were discussed and copies were provided to Manager Maribel Parks.the state’s words, verbatim · CDSS document, Nov 17, 2025

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaVette Farlow arrived unannounced to conduct the required annual visit to the facility. LPA met with Caregiver, Raquel Koemans, and introduced self and stated purpose of the visit. LPA was informed that there are currently 5 residents in care in the home. The facility has 4 resident bedrooms, 1 staff room/ office, 2 bathrooms, kitchen, dining area, living room, attached garage, and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 113.2 and 107.9 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, 1 fire extinguishers and emergency kit. Posters such as; the personal rights, ombudsman and emergency disaster plans were posted in a common area. LPA observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed in a secured filing cabinet and inaccessible to residents. LPA observed that 2 out of 2 residents in care MARs were incomplete and medication was not properly signed as being issued on the MARs log. Also, 1 resident in care medication was removed from it original container. Two deficiencies were sited. There are no firearms, ammunition, swimming pool or bodies of water. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff files for First Aid/CPR certifications, criminal record clearances, training's, and health screenings. LPA observed the Emergency Disaster Plan date 2024. LPA observed emergency drills conducted quarterly and on all shifts. Two deficiencies were issued and one technical advisory was cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and LIC9102 were discussed and copies were provided to Manager Yevette Hernandez.the state’s words, verbatim · CDSS document, Nov 19, 2024

Type of visit: Prelicensing

Licensing Program Analyst, Amber Coleman, (LPA) arrived at Cassandra's Care Home for a scheduled visit to conduct the Pre-Licensing Inspection. LPA approached the door, introduced self and stated purpose of the visit. LPA was greeted and granted entry by Cassandra Ellison, Administrator/Licensee. LPA was provided a space to set up and work, then provided a tour of the facility inside and out. LPA observed the following: Application: The application is for Residential Care Facility for the Elderly, (RCFE) submitted on 4/10/23. Fire clearance has been granted for five, (5) non-ambulatory residents and one, (1) bedridden resident. Fire clearance and inspection completed and approved on 7/10/23. Buildings and Grounds: The facility is a 1 level residential home. Facility is comprised of 5 bedrooms (4 resident rooms, 1 office), 2 bathrooms, kitchen, dining room, living room, attached garage and backyard. LPA observed the following signage throughout the facility: LET-US-KNOW, resident rights, resident council, labor laws, employee rights, visiting hours, evacuation/disaster plans, and infection control. Extra linens are kept in a hallway closet. Another hallway closet is designated to house cleaning supplies and tools. This hallway closet can also be secured. Facility in regulatory temperatures. Resident Rooms - each room included mattresses, mattress covers, bed linens, storage for clothing and belongings, intact windows and screens and sufficient lighting. Each room also included a floor plan with the evacuation route highlighted. 2 resident rooms contain a doorway entry into the facility's backyard. Both doorways included a cement ramp and railing for additional support and added safety. Bathrooms - There are 2 bathrooms, LPA observed each bathroom equipped with railing inside the showers and non-slip grip mats on the floor. Bathrooms also included a walk in shower and raised toilet seats. One of the bedrooms' includes an attached bathroom. Food Service/Kitchen: LPA observed the facility kitchen. Appliances observed to be functional and in good repair. Silverware, dishes and cups stored in adequate amounts for the number approved residents. The designated area for sharps and additional cleaning supplies are secure cabinets and drawers. The kitchen pantry is also houses the facility's first aid kits. The water temperature was tested and measured between 110-120 within regulatory limits. Living Room/Dining Area- included adequate seating, and a television. Activities such as board games, connect four, checkers/chess, bingo observed in the dining room; accessible for resident's use. The facility maintains an internet connection and working landline phone for residents. Storage and Supplies: Facility Records, Staff/Resident files are designated to be stored in the facility office; which is also secure. Backyard: included adequate seating, shade and space for activities. During the walk through, LPA observed that the facility formerly had a pool, has filled it in. No pools or body of waters on facility grounds. The backyard also contains a firepit, but the gas line has been removed, per Administrator. Exterior pathways were clear and unobstructed. Administrator and Licensee report there are no weapons or ammunition kept in the facility. LPA walked through the facility garage. The facility's washer and dryer is housed in the garage. Garage door is secure. The garage contained securable cabinets for laundry detergent/bleach. Overall, the facility is clean, in good repair, and operating in safe conditions. Pathways interior and exterior free of obstructions. LPA observed combination smoke/fire and carbon monoxide alarms throughout the facility. 2 fully charged fire extinguishers - purchased October 2023. No deficiencies were observed during inspection. LPA will inform the Centralized Applications Bureau the home is ready to be licensed. An exit interview was conducted. This report was reviewed, discussed then provided to Cassandra Ellison.the state’s words, verbatim · CDSS document, Nov 6, 2023

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Cassandra Ellison (applicant/licensee, administrator) Interview Method: microsoft teams On [DATE], applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and 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, Oct 18, 2023