Cely's Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to conduct the annual inspection, LPA met with the Facility Administrator Cecelia Reyes. the facility is licensed for 6 nonambulatory one of which may be 1 bedridden. There are 1 client has o2 administration, 2 have diabeites, 3 have dementia. 3 are non-ambulatory. There is not an exception on file for the o2 administration insulin dependant diabetes, Administrator will work the LPA to file the exeption paperwork, begining with a formal request for an exception to be recived by the LPA in writing, noel.wolfpetersen@dss.ca.gov by end of day tomorrow 1/29/2026 Physical inspection includes a converted garage, there are 4 rooms, Bedridden room on the facility sketch is designated as room 3 or room 4. Physical inspection included the kitchen, bedrooms, bathrooms, common areas, storage areas, exterior, and evacuation route gate. Evacuation route gate is obstructed by a heavy spring that renders an unnessisary resistance to opening the gate more than a 20*, LPA is asking the spring to be reinstalled to a position where the door could be opened 90*, or be removed. Administrator adjusted the spring tension. Fire extinguisher is dated 10-17-25. CO/smoke alarm is functional, water temp is measured at 114.5*F. LPA interviewed 1 client, 1 clients is out of the facility, 1 client retired for the evening. LPA interviewed 1 staff. Continued C-Page. Admin files were reviewed, including but not limited to: admin certificate(expiring 5.8.26), LIC 500(Staff schedule has 17 hours of coverage week days, week nights seems to have a 7 hour vacancy from 11pm-6am, staff schedule has 9 hours of coverage on the weekends, weekends seem to have a 15 hour vacancy from 3pm-6am), Aministrator provided there she and her husband are live in monday to friday, 1 additional staff is to be hired, LPA gave guidance night supervision requires on call on premises staff, and staff should have 5 hours of break between shift. LIC 9020(client Roster), Hiv Training, Fire drill record, Emergency preparedness, Infection control Plan, required posters(Personal rights, Ombudsman, facility license, facility sketch), and Plan of Op(control of the property via grant deed, surety bond(no bond) and liability insurance) are up to date and present. Client files were reviewed, including but not limiting to: recent medical assessments, admission agreements, functional capability assessments, and needs and services plans. Client exhibt restricted conditions: o2 administration due to copd, insulin dependant diabedies, facility does not have these services covered in ammendments toPlan of Op or having adequate trainings(4 hours per) for staff. Lpa gave guidance that more of the yearly training should be devoted to the following topics: wandering, diebetes, 02 administration. Needs and services plans read as the same for folks and are unfilled out in some portions. LPA gave guidance to contextualize needs and services plan to the specific needs of the clients. Admission agreement contains prohibited terms(refund conditions only allow for 15 days of basic services after the death of the resident.) LPA gave guidance that terms meet admission guidlines. LPA is requesting a copy of the updated admission agreement and the needs and services plans 2/5/26. Staff files were reviewed, including but not limited to: first aid training, continuing education, and criminal background check, health screening. Most annual training records are due for January, some records are out of date by a few days. Staff training is inadequate for restricted condition care, staff should have 4 hours annually for each restricted condition. LPA gave guidance to seek a licensed medical service provider outside her current employ to run an inservice for the restricted condition care for all employees. no citation was issued, a copy of the report was given. Exit interview was conducted.the state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived at this facility unannounced to conduct an post licensing inspection visit. LPA met with the administrator Cecilia Reyes and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly (RCFE) with a current census of 4. Facility has 4 bedrooms and 2 bathrooms for resident use. 1 extra bedroom is for staff use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 0 ambulatory residents, 4 non ambulatory residents, 0 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 74*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 9-15-24. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. Fire drill was conducted on 1/2025. During this inspection 4 resident files and 2 staffing files were reviewed for regulatory compliance. All files contained required contents. All staff noted on LIC 500 contained criminal background clearances. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Cecilia Reyes.the state’s words, verbatim · CDSS document, Feb 21, 2025

Type of visit: Post Licensing

On 6-18-2024 at 10:59am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an post licensing inspection visit. LPA met with the administrator Cecilia Reyes and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly (RCFE) with a current census of 5. Facility has 4 bedrooms and 2 bathrooms for resident use. 1 extra bedroom is for staff use. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 0 ambulatory residents, 5 non ambulatory residents, 0 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 78*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 9-15-24. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 5 resident files and 4 staffing files were reviewed for regulatory compliance. All files contained required contents. All staff noted on LIC 500 contained criminal background clearances.{Cont on LIC 809C} Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Cecilia Reyes.the state’s words, verbatim · CDSS document, Jun 18, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility on 3/20/2024 at 10:15am and was met by the Applicant Cecelia Valerio Reyes, and Administrator Maria Cleotilde Brelin. Brief interview was conducted with the Applicant. It was learned that this facility will be licensed as an Residential Care Facility for the Elderly (RCFE) to serve up to 0 ambulatory clients, 5 non-ambulatory clients, and 1 bedridden. There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. Exit signs in place as appropriate. Fire extinguisher in place at kitchen area and fully charged. Facility map indicating emergency exits posted in appropriate locations. Complaint poster and Ombudsman Poster observed. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet, located in the hallway, was observed to locked and secure. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. {Cont. on 809C} A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. This facility has been found to be in compliance at this time. There were no deficiencies observed during today's Pre-licensing visit. Component III completed with applicant during visit. Exit Interview conducted with applicant Cecilia Valerio Reyes. A copy of this report was left with the Applicant.the state’s words, verbatim · CDSS document, Mar 20, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Census (if any clients in care): 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, Jan 23, 2024