Delta Home Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Assistant Administrator Danielle Maximo. The facility serves elderly residents ages 60 and older whom are developmentally disabled. The facility is licensed as a level 4 RCFE vendored by San Gabriel/Pomona Regional Center. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed and includes environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment. Operational Requirements: A hospice waiver for 4 residents is approved. A fire clearance was granted for 4 non-ambulatory residents. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 6/20/2026. Facility handles resident P & I monies. The Surety bond expires 2/8/2028. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 4 private resident bedrooms, 2 bathrooms, living room, dining room/kitchen, outdoor patio area with patio furniture, and 2 car detached garage with laundry area. Smoke and carbon monoxide detectors were tested and are operational. The facility has one (1) fire extinguisher. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. The last Emergency Disaster drill was conducted on 10/4/2025. Bedroom #3's mini blinds are in disrepair/torn and bedroom #2’s door that exits to the side yard has a gap on the left side of casing/door closure area. Staffing: A total 6 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 7/20/2026. Staff have criminal background clearance and training. Six (6) staff files were reviewed. Proof of continuing education/staff training, health clearance, and 1st Aid/CPR training is current. Resident Records/Incident Reports: Four (4) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent, and Medication Administration records. R1'R4's Physician Reports are incomplete. RCFE and Ombudsman complaint posters are posted in the facility. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council due to cognitive impairment of residents. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. One (1) resident requires a modified diet. Incident Medical and Dental: Centrally stored resident medications were reviewed. 30-day supply of medications was observed. Medical and dental transportation is provided by facility staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: No residents receive hospice care or home health services at this time. No residents have prohibited health conditions. Two (2) residents are currently at a higher level of care facility. Pursuant to Title 22, deficiencies were cited. An exit interview was conducted with Assistant Administrator Danielle Maximo. A copy of the report and appeal rights was issued.the state’s words, verbatim · CDSS document, Oct 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to staff Ricardo Evangelista. Assistant Administrator Danielle Maximo arrived shortly after. The facility is licensed as an RCFE (Residential Care For the Elderly) for four (4) non-ambulatory developmentally disabled adults ages 60 and over. The facility is licensed as a level 4C RCFE vendored by San Gabriel/Pomona Regional Center. The following 12 Care Compliance and Regulatory Enforcement (CARE) tool domains were utilized during the inspection. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: A fire clearance for 4 non-ambulatory residents ages 60 and over was approved on 6/2/2022. Facility handles resident P & I monies and has a current Surety Bond that expires 4/22/2026. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility has one (1) fully charged fire extinguisher and a fire pull alarm in the living room. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances were observed locked and inaccessible to residents. Staffing: A total of 8 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 7/10/2024. Proof of pending approval from CCL Recertification Unit was provided. Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health and TB clearance, and 1st Aid/CPR training are on file. Proof of in-service training that includes HCBS Final rule was observed in staff files. ****Report narrative continues next page.***** Resident Records/Incident Reports: Four (4) resident files were reviewed. They contained admission agreements, IPPs, Behavior Plans, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. Centrally stored medication records are in place. Residents (R1- R4's) medical assessment forms were signed by MD, but not completely filled out. A citation was issued. Resident records included updates that fulfill Home and Community-Based Services (HCBS) Federal Requirements. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Daily activities and weekly calendar of activities was reviewed. The facility has a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. One (1) resident has a modified diet plan. Incident Medical and Dental: Centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by facility staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. The last emergency disaster drill was conducted on 10/3/2024.. Residents with Special Health Needs: No residents are receiving hospice services or home health services. There are no residents have a restricted health care plan. A deficiency was cited. Exit interview was conducted with Assistant Administrator A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Dec 3, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Administrator Rosamaria Maximo. Assistant Administrator Danielle Maximo arrived later. There are four (4) level 4C developmentally disabled adults over the age of 59. The facility is vendored by San Gabriel/Pomona Regional Center. A fire clearance for 4 non-ambulatory adults is in place. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer being screened for COVID-19. The facility has an Infection Control Plan. Operational Requirements: The facility has a Dementia plan and hospice waiver for four (4) residents. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 6/20/2024. Facility handles resident's money. A Surety Bond in the amount of $2,000 is in place. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood. The facility is staff operated and consists of 4 private resident bedrooms, 2 bathrooms, living room, dining room, kitchen, outdoor patio area and laundry area in 2-car attached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Kitchen drawers containing knives/sharp objects were locked. The facility has one (1) fully charged fire extinguisher, fire pull alarm, and operable carbon monoxide and smoke detectors. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Citation was issued. Staffing: A total of 10 caregiver staff provide care and supervision to the clients. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. Files contained admission agreements, Physician's Reports, Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted in the facility. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed twice a week. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. Incident Medical and Dental: Four (4) centrally stored resident medications were observed to have a 30-day supply of medications. Medical and dental transportation is provided by facility staff. See next page. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 10/14/2023. Residents with Special Health Needs: No residents are receiving home health services or enrolled in hospice care. Postural support physician orders are on file. No bed rails for mobility assistance were observed in resident beds. Individual Service Plans and Appraisals were observed in resident files. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Assistant Administrator Danielle Maximo. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Nov 9, 2023