Devoted Hearts Senior Care Home

Type of visit: Required - 1 Year

On 10/24/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. LPA introduce self, stated the purpose of the visit and met with staff Rizaline Osuna. Licensee/Administrator Leticia Jackson was called and arrived shortly. All five residents were present during inspection. Residents were observed in the common area and in the bedrooms. LPA toured facility with Licensee. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. All residents’ bedroom were toured and observed to have the required furnishings and with adequate lightning. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 40 degrees F and freezer at -4 degrees F. Fire extinguisher was observed with a service date: 01/08/25. Last fire drill was completed on 10/01/25.At 10:24AM, medications were observed unlock on the kitchen counter next to the stove. Medications were check and MARs were reviewed. LPA toured kitchen and observed cleaning chemical stored and locked under kitchen counter. The bathrooms were toured. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 106.4 degree F in the bathroom 1 and maintained at 107.2 and 108.9 degree F in master bathroom. Extra linens and towels were observed. Outside of facility toured and observed to be free of debris. Side exit observed self-closing and self-latching. Adequate outdoor seatings available for residents. Sample of residents’ and staff files were reviewed. Carbon monoxide and smoke detector operational during visit. A civil penalty is being cited, per California Code of Regulations, Title 22, Division 6, see attached 421IM. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 10/30/25: Lic 308, Lic 500, Lic 610E, and current liability insurance. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Oct 24, 2025

Allegation investigated: Staff did not allow a resident to use the bathroom.

On 10/06/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Licensee/ Administrator Leticia Jackson. LPA discussed complaint findings with Licensee. During the course of the investigation, the department conducted interviews, toured the facility, and reviewed records. Based on interviews conducted, there is insufficient evidences to prove or disapprove that staff did not allow resident to use the bathroom. Therefore, the preponderance of evidence standard has been met, therefore, the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 6, 2025 · control 24-AS-20251001095140

Allegation investigated: Staff do not provide adequate food service Staff mishandled the residents medications

On 09/09/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation. LPA introduced self, stated the purpose of the visit and met caregiver Rizaline Osuna and Liza Fortun. Staff called Licensee/ Administrator Leticia Jackson who arrived later during investigation. During the course of the investigation, interviews were conducted, records were reviewed, and facility was toured. Adequate nonperishable and perishable food were observed and provided. Destructive medications are recorded, stored and locked in kitchen cabinet. Based on interviews conducted, observation, and records reviewed, therefore the preponderance evidence has not been met, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 9, 2025 · control 24-AS-20250908131535

Type of visit: Case Management - Deficiencies

On 09/09/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced initial complaint investigation and met with Licensee/ Administrator Leticia Jackson. During the course of the investigation, LPA toured the facility, reviewed records, and conducted interviews. Medications were checked and MARs was reviewed. Expired food was observed. R1 whose receiving hospice care was observed lying in bed in a hospital bed with full rails. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Sep 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(8) · Plan of correction due date: Sep 10, 2025

87555(b)(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state, and local authorities. Good in damaged containers shall not be accepted, used, or retained. This requirement is not met as evidenced by: Based on observation, expired nonperishable food was observed, poses/posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: Licensee immediately disposed expired food. POC cleared during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(c)(2) · Plan of correction due date: Sep 10, 2025

87465 (c)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on interviews, observation, and records review, R1 and R2’s morning medications were not administered on 09/09/25 as directed by physician, which poses an immediate health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: All staff will have in-service training which will also include administering medications and medication documentation. Licensee will submit documentation of training topics and staff attendance roster to the Fresno CCL office by POC due date 09/10/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Sep 12, 2025

87608(a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation and records reviewed, R1 is receiving hospice care using hospital bed with full rail with doctor’s order for half rail, which poses/posed a potential health and safety and personal rights risk to the resident in care.the state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: Full bed rails are prohibited. Licensee shall obtain doctor orders for R1 who’s currently receiving hospice care that specific the need for full bed rails and submitted to the Fresno CCL by POC due date 09/12/25.

Type of visit: Required - 1 Year

On 12/19/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. introduce self, stated the purpose of the visit and met with staff Sonia Bautista. Licensee/Administrator Leticia Jackson was called and arrived shortly. All five residents were present during inspection. Residents were observed in the common area and in the bedrooms. LPA toured facility with Licensee. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. All residents’ bedroom were toured and observed to have the required furnishings and with adequate lightening. At 10:24AM, medications were observed on side table and television stand in room 1 unlock. At 10:29AM, medications and alcohol bottle were observed in room 2 closet unlock. Alcohol bottle was observed in staff closet in living room unlock. Fire extinguisher was observed with a service date: 01/18/24. LPA toured kitchen and observed cleaning chemical stored under kitchen counter unlock. Discontinued medications were observed stored under kitchen counter next to stove unlock. An adequate supply of perishable and non-perishable food was observed. Refrigerator temperature is maintained at 32 degrees F and freezer at -3 degrees F. Washer observed operational during visit. At 10:51AM, LPA observed a large box fill with cleaning bottles stored in the garage unlock. Refrigerated medications were observed in mini refrigerator unlock in the garage next to large chemical box. Knives were observed stored in a metal cabinet in the garage unlock. Paint cans were observed in the garage back wall unlock. The bathrooms were toured. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 114.9 degree F in the bathroom 1 and range at 110.8 and 111.4 degree F in master bathroom. Extra linens were observed. Outside of facility toured and observed to be free of debris. Side exit observed self-closing and self-latching. Adequate outdoor seatings available for residents. Medications were observed locked in cabinet in common area. Residents’ MARs and medications were checked. Sample of residents’ and staff files were reviewed. Carbon monoxide and smoke detector operational during visit. Technical Support Program (TSP) assistance was offered to Licensee. Licensee will make a decision and reach out the department regarding acceptance. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 12/26/24: Lic 308, Lic 500, Lic 610E, Lic 9282, current liability insurance, and Administrator certificate. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Dec 19, 2024

Type of visit: Prelicensing

On 12/13/23, Licensing Program Analyst (LPA) M. Yang arrived announced to conduct a follow-up Pre-licensing inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensee Leticia Jackson. On 12/01/2023, Licensee informed the department currently there are 5 non-ambulatory and 1 bedridden residing in the facility. The department was informed 1 bedridden resident was relocated prior to Fire inspection on completed on 11/21/23. Resident in bedroom 1 is non ambulatory and resident in bedroom 3 is bedridden. LPA observed a total of 2 non ambulatory, 1 bedridden, and 3 ambulatory residents. Fire clearance granted for 5 non-ambulatory and 1 bedridden for total of 6 capacity. Facility is in compliance and no follow up visit is needed. Facility is ready to be licensed. I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. An exit interview was conducted. A copy of this report was provided to Licensee, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Dec 13, 2023

Type of visit: Prelicensing

On 10/16/23, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing and Component III inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensee Leticia Jackson. LPA toured facility with Licensee. The facility is 4 bedroom and 2-bathroom home. Fire clearance was granted for 6 non-Ambulatory for total of 6 capacity. LPA toured the facility with Licensee. All four residents were present during this inspection. LPA observed 2 bedridden residents in bedroom 1 and bedroom 3. The facility was observed to be at a comfortable temperature of 76 degrees F, furnished with adequate seating. A fire extinguisher was observed and has a service date of 01/11/2023. Medications were kept locked in kitchen shelf. Kitchen was toured and observed to have dishes, plate, and utensils. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -4 degrees F and refrigerator temperature was maintained at 40 degrees F. Knives were observed to be locked and secured in kitchen shelf. Cleaning chemicals was observed stored and locked in under kitchen counter. LPA observed an extra supply of bed linens and personal hygiene products. Bedrooms were observed to have required furnishings. All bathrooms toured and operational during inspection. LPA observed bathroom with securely fastened grab bars and non-skid mat. Hot water measured at 111.8 degrees F in bathroom 1 and 105.9 degrees F in the master bathroom. Washer and dryer observed operational during inspection. Outside of facility toured. LPA observed side gate to be self-closing. Carbon monoxide and smoke detectors were tested and observed to be operational. First aid kit observed to have all required items. All resident records were reviewed. LPA observed resident Admission Agreements, Physician Reports, and Pre-Appraisal. Staff records were reviewed. Personnel records observed to have a criminal record clearance. LPA have founded the facility have not met all the Pre-Licensing requirements. Component III was conducted during today's pre-licensing visit. An exit interview was conducted. A copy of this report was provided to Licensee, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Oct 16, 2023