Crystal Springs Care Home

Type of visit: Case Management - Other

On March 4, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced case management- facility closure visit. LPA met with Licensee Albertina Camaclang and explained the purpose of the visit. Licensee notified CCLD of facility closure on 2/26/2026 as the licensee is no longer interested in maintaining a license. LPA toured the facility and observed the kitchen, living room, dining room, bedrooms, bathrooms and common areas. LPA did not observe any residents and did not observe evidence of care and supervision in the home. CCLD will be proceeding with the closure. A forfeiture letter will be sent to licensee and the facility number 411408931 shall be closed. During the visit, licensee surrendered facility license. This report is reviewed, and discussed with the Licensee, and a copy is provided.the state’s words, verbatim · CDSS document, Mar 4, 2026

Type of visit: POC

On March 17, 2025, Licensing Program Analyst (LPA) Murial Han conducted a plan of correction visit for the annual inspection that was conducted on March 4, 2025. LPA met with caregiver, Consuelo Iman and explained the purpose of the visit. Caregiver, called and informed administrator, Genny Flores of LPA's visit. During today's visit, LPA toured the common areas, bath/shower room, dining room, living room, resident room, etc., reviewed the deficiencies with administrator over the phone and reviewed documents. The following deficiencies , which were cited on 3/4/2025 are corrected: - 87303(a) Maintenance and Operation - 87303(a)(1) Maintenance and Operation - 87303(c) Maintenance and Operation - 87309(a) Storage Space and Access - 1569.695(c) Emergency Drills - 87457(c) Pre-Admission Appraisal - 87463(a) Reappraisal In regards to Postural Support 87608(a)(3), the administrator has requested for an extension and it was granted. A copy of the Cleared Plan of Correction Letters provided the caregiver. No deficiency cited today. This report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Mar 17, 2025

Type of visit: Required - 1 Year

On March 4, 2025, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with Caregiver, Consuelo Iman and explained the purpose of the visit. Caregiver called and informed the administrator of the inspection visit. The administrator arrived during the inspection. Caregiver provide a toured of the facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA toured the facility inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed 3 private resident rooms and 1 shared room. Rooms were spacious and included all required furnishings. The bath/shower room for the residents was equipped with paper towels, soap, grab bars, and non-skid mats. The shower floor observed to be dirty, and soiled clothes were place on the floor to prevent water from overflowing to the toilet side. During the tour of the facility, LPA observed fruit files thought-out the facility, a black plastic garbage can in the kitchen appeared to be greasy, have many brownish and whitish particles, the kitchen floor has hair, dirt, and used Q-tip, the kitchen sink has a plastic bag tide around the faucet with garbage inside, the closet door in R1's room is broken, spider webs on the window frames, light fixtures, etc., a white bucket by the refrigerator in the kitchen has black dust inside and an unidentified electrical device, toaster over in the kitchen was greasy and filled with dried brown and black particles, the floor board trims through-out facility appeared to black, brown with chipped paint. LPA observed sharps were opened and accessible to residents in care. In addition, the sharps drawer appeared to be dirty and the sharps appeared to be old and rusty. Hot water temperature in the kitchen, and bathroom was measured at 105- 109 degree F. Extra linen was present. Medications were locked and inaccessible to residents. 2 days for perishables and & 7 days non-perishable were observed to be present. A review of (3) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. Civil penalty of $500 is being assessed for 2 repeat violations that were observed during the annual inspection in 2024. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in additional civil penalties. LPA provided an exit tour to the administrator and identified the deficient areas that were cited today. The administrator will provide a copy of the administrator certification and the liability insurance by 3/6/2025. This report is reviewed and discussed with administrator. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 4, 2025

Type of visit: Required - 1 Year

On March 27, 2024, Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with Caregiver, Consuelo Iman and explained the purpose of the visit. Caregiver called and informed the administrator of the inspection visit. Caregiver provide a toured of the facility and grounds. No accessible bodies of water or fire safety hazards observed. LPA toured the facility inside and outside including all of resident rooms, common areas, and kitchen area. The indoor and outdoor passageways were free of obstruction. Comfortable temperature is maintained and lighting is sufficient for comfort. LPA observed 3 private resident rooms and 1 shared room. Rooms were spacious and included all required furnishings. The bath/shower room for the residents was equipped with paper towels, soap, grab bars, and non-skid mats but it appeared to be dirty with brownish stains on the non-skid mat and shower drain. In addition, the garbage can has rusty stains as well as the metal toilet paper holder that is next to it. LPA observed strong urine smell by the entrance, in the resident's bathroom and in one of the resident's room. LPA also observed fruit files in the kitchen area, the garbage can in the kitchen appeared to have many brownish and whitish particles, the floor in shared resident's room have dried liquid stains, black particles, dust, etc. Hot water temperature in the kitchen, and bathroom was measured at 108- 115 degree F. Extra linen was present. Medications, toxins and sharps were observed to be locked. 2 days for perishables and & 7 days non-perishable were observed to be present. Facility is equipped with smoke detectors and carbon monoxide detectors. A review of (4) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with caregiver and administrator who was on the phone. A copy of this report and the appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 27, 2024