Charlou Guest Home IV

Type of visit: POC

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit to the facility for the purpose of conducting a POC inspection visit to verify correction of citations issued during the annual visit conducted on June 29, 2026. LPA was greeted and granted entry by Administrator Dolores Benedicto after explaining the purpose of the visit. Based upon this inspection, LPA observed the following: *Deficiency cited under Title 22 Regulation 87309(a) has been cleared. LPA observed all items in back patio storage shed to be removed. Based on today's visit no deficiencies are being cited. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 14, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry after explaining the purpose of the visit. Administrator (AD) Dolores Benedicto assisted with the inspection. LPA observed the Administrator certificate was current with an expiration date of January 13, 2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents with a hospice waiver for six. The facility is a one-story home with four resident bedrooms , four staff rooms one of which is labeled as a staff rest area, one resident bathroom, 2 staff bathrooms, a family room, living room, kitchen, dining room, bar, and an attached garage with an exterior entrance. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPA observed residents sitting at the dinning table in the dining room and resting in their respective bedrooms. LPA observed four residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the dining room. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPA observed bathrooms were clean and equipped with grab bars and non skid floors. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 110.6 and 113 degrees Fahrenheit. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of June 12, 2025. Fire Safety appointment is scheduled for June 30, 2026. Gas stove, microwave, dish washer, washer and dryer were all inspected and observed to be operable. LPA observed knives and sharps to be stored in a locked kitchen walk-in pantry. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents in the laundry room, however toxic chemicals, sharps, and paint were observed to be stored in a separate storage outdoor cabinet that was not locked; a deficiency was cited on today’s date. Medication cabinet was observed to be locked and centrally stored in the hallway leading to the backyard. LPA observed the First Aid Kit had all the required components. LPA observed the facility conducted their last emergency disaster drill on January 2026. LPA began review of the records. LPA Guillen reviewed four resident records. All the required documentation were present and current in the resident files reviewed. LPA reviewed two employee records. All employees present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificates. Based on the observations made during today’s inspection, a deficiency is being cited. An exit interview was conducted, and a copy of this report, appeal rights and Legionnaire’s Disease fact sheet was left at the facility.the state’s words, verbatim · CDSS document, Jun 29, 2026

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hanna Gough arrived at the facility to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Dolores Benedicto and explained the purpose of the visit. The facility currently has four residents in care. The facility is a one-story home with five resident bedrooms, one staff bedroom, one resident bathroom, one staff bathroom, kitchen, dining room, living room, family room, backyard and attached 2-car garage. The facility has two rooms that are inaccessible to residents that are for the licensees family. The facility appears clean, safe and sanitary. LPA observed all the required departmental postings throughout the facility. LPA observed that all resident bedrooms had the required components and furnishings. The resident restroom had toilet paper, paper towels and textured flooring in the shower. LPA tested the water to be at 105 degrees Fahrenheit. LPA observed a clean supply of linens in the hall closet located by three of the resident rooms. LPA observed the kitchen to be free of vermin. LPA observed a two day perishable and seven day non-perishable food supply on hand. LPA observed the sharps to be locked in the kitchen pantry and made inaccessible to residents. LPA observed the toxins and chemicals to be locked in the laundry room and made inaccessible to residents. LPA observed a fire extinguisher in the pantry charged and with a service date of June 12, 2025. LPA observed the centrally stored medication to be in a locked cabinet located by the fourth resident bedroom. LPA observed the emergency food and water supply. LPA observed the backyard to be free of obstructions. LPA observed the backyard to have a shaded seating area for resident use. LPA observed the shed in the backyard used for storage. LPA and AD tested the fire alarm and smoke detector and they were found to be operational. Continue on 809-C LPA reviewed resident files and no discrepancies were observed. LPA reviewed resident medication and no discrepancies were observed. LPA reviewed staff files and 2 of 3 staff do not have the 20 hour annual training. LPA observed that the last fire drill was conducted on May 1, 2025. All staff present, as well as the licensee’s live in family are background cleared and associated to the facility. Based on today’s inspection a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Dolores Benedicto and a copy of this report along with LIC809-D, LIC859 and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 1, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into facility by Dolores Benedicto, Licensee. The facility is a one-story home with five resident bedrooms, one staff bedroom, one resident bathroom, one staff bathroom, kitchen, dining room, living room, family room, backyard and attached 2-car garage. A section of the home is blocked off from resident access. This part of the home houses family of the Licensee. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for residents in the hallway closet. Restrooms are stocked with soap and paper towels. LPA measured water in resident bathroom to be 110.4 degrees Fahrenheit. LPA noted Fire Extinguishers were last serviced on 06/17/2024 according to the service tag on them. LPA observed the smoke/carbon monoxide detectors to be operational. Facility keeps emergency water and emergency disaster supplies in the garage. LPA observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets. Knives are locked up separate from toxic chemicals. Medication for each resident is kept locked in a closet in the hallway. The backyard has a shaded sitting/lounging area. Exit gate is unlocked. LPA observed exit gates to be unobstructed. LPA observed a sample menu and activity calendar in the facility. LPA reviewed two of the four resident files and two staff files. LPA also reviewed medication for two out of four residents. LPA interviewed one resident and one staff. Based on record review, LPA determined facility does not have a documented disaster drill log. A deficiency is being issued. Based on record review, LPA advised facility to create a dementia care plan, hospice care plan and bedridden care plan to maintain in the facility plan of operations. LPA issued three Technical Violations (TVs). One deficiency and three TVs are being issued based on today's inspection. An exit interview was conducted and a copy of this report and appeal rights were provided to the facility.the state’s words, verbatim · CDSS document, Jul 22, 2024

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.