Delicare Health Services

Type of visit: Required - 1 Year

On 12/15/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Assistant Administrator (AA), Keith Pollard who was informed of the purpose of the visit. Administrator, Sameh Awad was phoned also informed of the purpose of LPA's visit. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents of which one (1) may be bedridden. The facility also has an approved hospice waiver for two (2) and LPA was informed only one (1) resident is currently receiving hospice services at the facility. Staff present has a criminal record clearance and is associated with the facility. LPA toured the facility with AA Pollard and observed the facility is made up of a one-story home with five (5) resident bedrooms, one (1) bathroom, a kitchen, dining area, living room, laundry room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. The bathroom had a grab bar and a non-skid mat in the shower. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility had more than a two-day supply of perishable foods and seven-day supply of non-perishable foods. Medications are secured in a locked kitchen cabinet. AA Pollard tested one (1) of the smoke alarms and carbon monoxide detectors and LPA observed them to be operational. LPA also observed two (2) charged fire extinguishers mounted in the facility. Cleaning solutions and chemicals are secured in the locked laundry room. The facility has several towels, bedding and linens available in different colors for the residents in care. The facility's certificate of liability insurance expires on 02/17/2026. LPA reviewed the facility's Drill Log noting the facility's last fire drill was conducted on 11/18/2025. Long Term Care Ombudsman's contact information, residents' personal rights, complaint procedures and facility sketch are visibly posted in the facility. No citations were issued during today's visit. An exit interview was conducted and a copy of this report was reviewed and provided to AA Pollard.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Case Management - Health Checks

On 09/10/2025, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conduct a case management visit to deliver an Immediate Exclusion order dated 09/09/2025 for Staff, Ismael Loyola. LPA was greeted and granted entry by Caregiver, Leonora Martinez who was informed of the purpose of the visit. Caregiver Golandam "Rose" Ghahremani was also present during the visit along with four (4) residents. Staff present have a criminal record clearance and are associated with the facility. Administrator Sameh Awad was contacted over the phone and reported he unavailable to meet with LPA at the facility at the time of the visit. Administrator Awad was informed of the purpose of the visit and requested LPA leave the Immediate Exclusion order for Loyola with Caregiver Martinez, as Administrator Awad is scheduled to visit the facility later this afternoon. LPA toured the facility with Caregiver Ghahremani and did not observe Loyola present or any imminent health or safety concerns. No deficiencies were issued during today’s visit. An exit interview was conducted with Caregivers Martinez and Ghahermani where this report was reviewed. LPA handed this report and the Immediate Exclusion order for Loyola to Caregiver Martinez as requested by Administrator Awad.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ferrer Sabarias and Licensing Program Manager (LPM) Tricia Danielson conducted an unannounced annual required visit. Upon entry, LPA and LPM was greeted by Caregiver Saira Aguirre and informed her of the purpose of the visit. At the time of the visit, there were two staff members and five residents present. Facility Overview: The facility is a one story home with five bedrooms for residents, one bedroom for staff and three bathrooms, including an attached garage. There are no pools in the premises. Infection Control: LPA and LPM observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. According to the Administrator there are no firearms kept in the facility. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 119.8 F in the bathrooms the residents is utilizing. Fire extinguishers are in working order, last service date 11/26/2024. Continue to LIC809C Continued from LIC809 Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate valid until 4/8/25. Record Review and Resident/Staff Files: LPA reviewed files for two staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for four residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. All facility exits were clear of obstructions. No deficiencies will be cited during the visit. An exit interview was conducted, during which this report was reviewed and provided to Administrator Sameh Awad.the state’s words, verbatim · CDSS document, Nov 26, 2024

Allegation investigated: Licensee is not adhering to proper eviction procedures with resident in care.

Licensing Program Analyst (LPAs) Sara Martinez conducted an unannounced visit to the facility to initiate the complaint investigation regarding the allegation above. LPA conducted a tour of the facility, interviews, and requested pertinent documents related to the investigation. Regarding the allegation "Licensee is not adhering to proper eviction procedures with resident in care" it was reported Resident One (R1) received an three (3) day eviction that did not adhere to Title 22 Regulation 87224 and Health and Safety Code 1569.683. R1's Power of Attorney (POA) received a text message from Administrator Sameh Awad on 10/14/2024 stating "Mandatory Eviction 10/16/2024 Last day tomorrow 10/15/2024". The Department has not received a written request from the Licensee for a three (3) day eviction notice for R1. Interview with Administrator Awad revealed due to R1's behaviors, a text message was sent to R1's POA informing them of a three (3) day eviction for R1. On 10/15/2024 the Department received a thirty (30) day eviction notice for R1. Substantiated LPA conducted a record review of the thirty (30) day notice and determined the thirty (30) day notice was not in compliance with Title 22 Regulations 87224 and Health and Safety Code 1569.683 and was denied by the Department. Based on LPA’s interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report, LIC 9099 D, LIC 811 - Confidential Names, and Appeal Rights was provided to Aguirre.the state’s words, verbatim · CDSS document, Oct 15, 2024 · control 18-AS-20241014164913

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(b) · Plan of correction due date: Oct 25, 2024

87224 Eviction Procedures (b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause...This requirement was not met as evidence by: Based on interviews and records review, the licensee issued a three (3) day eviction and thirty (30) day eviction tfor R1 hat was not in compliance with Title 22 Regulations and Health and Safey Code 1569.683.the state’s words, verbatim · CDSS document, Oct 15, 2024

Plan of correction: Licensee will continue to retain the resident and submit a ressission letter for the thirty day eviction notice prior to re-submiting. Licensee will submit a statement acknowleding they have read Title 22 Regulation 87244 and Health and Safety Code 1569.683 by the plan of correction date 10/25/2024.

Type of visit: Required - 1 Year

On 12/04/23 Licensing Program Analyst (LPA) Javina George arrived unannounced to the facility noted above to conduct an annual inspection. LPA was greeted and granted entry by Caregiver Leonora Martinez. LPA met with the Administrator Sameh Awad who arrived after LPAs arrival. Below is an account of LPAs observations of the conducted inspection: Physical plant: The facility was observed to be within the licensed capacity (6). The facility is a single story home with (5) resident bedrooms, (1) staff bedroom, (2.5) bathrooms, garage, living room, and backyard. The exterior was observed to be clutter free and well manicured. The video utilizes video surveillance, as cameras in all the common areas. The facility completed an addendum and obtained all required from the residents and their responsible parties. Interior: the resident bedrooms were observed to have clean mattresses, night stands, storage space, and sufficient lighting. Room temperatures were comfortable for residents in care. The bathroom appliances were operating in safe and sanitary conditions. LPA measured the hot water temperature in two (2) resident bathrooms, initially the water temperature was too hot, the water heater was adjusted and the water temperature ranges were retested and observed to be within regulatory limits of 108-114 degrees Fahrenheit. The carbon monoxide and smoke detectors l were observed to be operable. The facility was stocked with a 2-day supply of perishable and 7-day supply of non-perishable food items that were labeled appropriately. Dishes, glasses, and utensils were in good condition and stored in a healthful manner. There is a locked and centralized storage area for medications, which is located in the kitchen next to the refrigerator. The facility had a designated area for resident files and staff files. All staff present have a criminal record clearance on file and are associated to the facility. The facility was observed to have all the required postings such as Ombudsman poster, PUB475, LIC610E, and current administrator's certificate. The facility was also equipped with a complete first aid kit as well as the first aid manual. LPA inspected the outdoor area of the facility. There was shaded area with seating. The facility is in compliance as the business' governing body is active and functioning. Overall, the facility was clean odor free and in good repair. The following citations are being issued as the facility has not been conducting emergency disaster drills on a quarterly basis nor documenting the conducted drills. The citation can be found on the attached 809D. An exit interview was conducted and a copy of the report, 809D, and appeal rights were reviewed and provided to Sameh Awad, administrator.the state’s words, verbatim · CDSS document, Dec 4, 2023