Elderly Comfort Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:18 a.m., the LPA met with staff and explained the reason for the visit. At 10:59 a.m., the Administrator, Faver Alexander Miranda arrived at the facility. At 10:19 a.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:20 a.m., hot water measured at 109.0-degree Fahrenheit. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and two (2) bathrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:29 a.m., hot water measured at 105.3-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. OUTDOOR SPACE: At 10:31 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage/ storage area. The LPA observed additional food and water in the garage. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 11/24/2025. At 10:35 a.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Medications are located in a locked hallway closet. There is a working telephone on premises. The LPA observed a closet in the hallway with additional clean linens and towels. RECORD REVIEW: Between 11:00 a.m. and 12:30 p.m., the LPA conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Administrator’s Certificate is valid until 02/23/2027. Emergency drills are conducted quarterly, with the last drill documented on 12/25/2025. The LPA observed documentation of the Infection Control Plan and Emergency and Disaster Plan. Starting at 1:08 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for three (3) out of five (5) residents and observed the following: Resident #1 (R1’s) Eliquis 5 MG tablet had 25 tablets remaining, however the documented start date was 12/09/2025 and with the quantity listed as 200, meaning there should be a total of 84 tablets remaining instead. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency was observed and cited during the visit (See 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:40 a.m., the LPA met with staff and explained the reason for it visit. At 10:25 a.m., the Administrator, Faver Alexander Miranda arrived at the facility. RECORD REVIEW: Between 10:10 a.m. and 11:08 a.m., the LPA conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Administrator’s Certificate is valid until 02/23/2025. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated. Emergency drills are conducted quarterly, with the last drill documented on 12/14/2024. At 11:10 a.m., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and two (2) bathrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 11:22 a.m., hot water measured at 107.5-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC-809-C. OUTDOOR SPACE: At 11:16 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Laundry units are located inside the garage. Cleaning solutions are located inside the garage/ storage area. There are no bodies of water on the premises. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:23 a.m., hot water measured at 105.4-degree Fahrenheit. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 11/08/2024. At 12:27 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. Medications are located in a locked hallway closet. There is a working telephone on premises. The LPA observed a closet in the hallway with additional clean linens and towels. At 12:28 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for five (5) residents and observed that all medications were properly documented. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:45AM. LPA initially met with facility staff. Licensee/Administrator was contacted via telephone and arrived at 10:32AM. Entrance interview conducted. Beginning at 10:43AM, the LPA, along with Licensee/Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Hardwired smoke detectors and fire doors were tested at 01:58PM, separate carbon monoxide detectors were tested at 02:00PM. All were functional at the time of the visit. Fire extinguishers were observed to be fully charged and last serviced on 11/16/2023. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Adjacent to the kitchen is the locked facility garage, which contains a laundry area, locked chemical storage, extra food supply, emergency food and water as well as storage. BEDROOMS: There are 4 (four) total bedrooms, of which 2 (two) are designated for private resident use and 2 (two) are designated for shared use. Previously, the facility contained a staff bedroom, however Licensee requested conversion of the staff room to a resident room and fire clearance was approved on 07/22/2023. During today's visit, the LPA observed all resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Report Continued on LIC 809-C RESTROOMS: The LPA observed 2 (two) restrooms in the facility; 1 (one) is for shared use and 1 (one) is designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in the private resident restroom and measured within the required range. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. An adequately screened fireplace was observed in the living room. OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. All exits and passageways were observed to be free of hazards. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 3 (three) resident records were reviewed; all 3 (three) contained all required documents. 5 (five) staff files reviewed were complete and contained all required documents. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented on 02/04/2024. MEDICATION REVIEW: Medications for 2 (two) residents were observed. Both 2 (two) of 2 (two) residents' medications were observed to be maintained and administered in compliance with regulation. First aid kit was observed to be complete. INTERVIEWS: Throughout the visit, LPA interviewed 2 (two) residents and 2 (two) staff. No citations issued. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 15, 2024