Eastvale Senior Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Laarni Dizon and was granted entry to the facility. Licensed capacity is (6) current census (6). LPA was accompanied by Administrator Laarni Dizon to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. Hot water temperature tested at 105 degrees Fahrenheit. LPA Hernandez inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Hernandez observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine pantry with the resident’s medications locked. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. **Continuation on LIC809-C** Record Review: LPA Hernandez reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed three (3) residents medications. LPA observed Resident #1 (R1) prescribed syringes to be transferred to another unlabeled container. Deficiency will be issued. Additionally, LPA observed no appropriate PRN documentation for (3) clients in care. Deficiency will be issued. LPA Hernandez reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with Tuberculosis (TB) test result. No issues were observed Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Laarni Dizon.the state’s words, verbatim · CDSS document, Jan 16, 2026

Allegation investigated: Resident record is not completed.

Licensing Program Analysts (LPA) Raquel Hernandez conducted an unnannounced visit for the purpose of investigating the above allegation. LPA met with Staff Victoria Ochava and explained the purpose of the visit. The investigation consisted of facility tour and record review. For the allegation, Resident record are not completed. LPA Hernandez conducted a record review for former Client #1 (C1). During record review LPA observed no admission agreement for C1 or a completed record. Based on observations and record review, the allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. During today’s visit, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC9099, LIC9099C and LIC9099D were discussed and provided to Licensee Laarni Dizon along with a copy of appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Jan 3, 2025 · control 56-AS-20250102114408

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jan 10, 2025

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Based on observation and record review, licensee did not not comply with the section cited above by not ensuring former Client #1 (C1) had a completed record prior to moving into the facility, which poses a poential health, saftey, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 3, 2025

Plan of correction: Licensee and staff will read Title 22 regulation 87506 regarding Resident Records and send photo documentation confirming regulation was read by Plan of Correction (POC) due date. Additionally, licensee stated to not accept future residents with incomplete record.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Bene Molinitas and was granted entry to the facility. Licensed capacity is (6) current census (6). LPA was accompanied by Administrator Laarni Dizon to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. LPA observed cleaning supplies and knives unlocked accessible to clients in care. Deficiency will be issued. Additionally, LPA observed Client #1 (C1) medications located underneath the sink unlocked accessible to residents in care. Deficiency LPA observed facility is not in substantial compliance with requirements regarding hospice care residents as there are three (3) hospice care residents. Facility is only granted two (2). Deficiency will be issued. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA reviewed (4) resident medications **Continuation on LIC809C** LPA observed for Client #1 (C1), Client #2 (C2), Client #3 (C3) and Client #4 (C4) staff are not properly documenting PRN medication/administration. No date, time, resident's response was taken. Deficiency will be issued. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. No issues were observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) and (LIC809-D) was discussed and provided to Administrator Laarni Dizonthe state’s words, verbatim · CDSS document, Nov 14, 2024

Type of visit: Required - 1 Year

1300: Licensing Program Analyst (LPA) Amy Goldenberg arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA toured the facility inside and outside. LPAs observe the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the residents. Lighting is sufficient for safety and comfort. Water temperature measured 105.3 degrees F. Grab bars, non slip mats are present in the restrooms. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. Fire extinguishers are charged and mounted. All outdoor and indoor passageways are free of obstruction. Night lights and emergency lighting is present. A locked area is provided for medications and sharp objects. There is a telephone working at this location. The LIC 610E, emergency disaster plan is maintained. The facility has a current written definitive plan of operation. The facility does not handle resident money. LPA reviewed employee record for first aid certification, finger print clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. Food prep areas are clean and organized. There is adequate food supply. Six (6) client interviews were conducted. Two (2) staff interview was conducted. Based on the information received during this visit today, there are no deficiencies being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative.the state’s words, verbatim · CDSS document, Nov 28, 2023