Esther's Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Vivencio Ignacio and Licensee (LN) Esther Ignacio. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA observed the facility to be clean, safe, sanitary and in good repair. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed therefrigerator temperature at 37 F and Freezer at -6 F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 7/21/2025. The facility emergency drill log was reviewed. The facility's last drill was on 1/4/2026. LPA toured 4 resident bedrooms. All 4 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. Page 1 of 2 LPA toured 3 bathrooms. All 3 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 110.8 F to 112.1 F. LPA reviewed 2 resident records. Resident records included emergency contact information, physician’s report, needs and service plans, and personal rights. LPA reviewed 2 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 2 staff records. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator (ADM) Vivencio Ignacio and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Administrator (ADM) Vivencio Ignacio. LPA stated the purpose of the visit. ADM stated the facility has 4 residents. LPA observed 4 residents and 2 staff. LPA toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 37 degrees F and Freezer at -6 degrees F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested by ADM. Fire extinguishers were last serviced on 6/24/2024. LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was on 12/2/2024. ADM stated the facility will conduct a drill by 5/30/2025. LPA toured 6 resident bedrooms. All 6 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. Page 1 of 2 LPA toured 2 bathrooms. All 2 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 111.9 degrees F to 116.9 degrees F. LPA reviewed 4 resident records. Resident records included emergency contact information, physician’s report, needs and service plans, and personal rights. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA observed 2 out of 4 CSMDRs were not documented to include R2 and R4's recent prescription refills from April 2025. ADM stated understanding of Title 22 regulations for centrally stored medications. A Technical Violation was issued. LPA reviewed 4 staff records. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. No deficiencies were cited during today's visit per California Code of Regulations Title 22. A Technical Violation was issued, see LIC9102. An exit interview was conducted with Administrator Vivencio Ignacio and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Licensee (LN) Vivencio Ignacio. During the visit, LPA observed 5 residents and 2 staff. When the LPA entered the home, LPA asked for the staff members names. Staff S2 identified him/herself but his/her name did was not on the facility personnel Report Summary (LIS536). S2 stated he/she has been working at the facility for 3 weeks. LPA searched S2 on guardian and S2 is fingerprint cleared, but not associated to the facility. LPA toured the facility inside out with LN which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring the backyard, LPA observed some wooden planks, near bedroom #1's sliding screen door, in the backyard deck had openings. (Photographs taken.) LN stated he has been getting estimates from contractors to address the hole in the wooden planks. LN stated he was planning on fixing the damaged wooden planks by the end of next week. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 116 degrees F in resident bathrooms. Page 1 Out of 2. Fire extinguisher was serviced in July 16, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by LN, and were functional. LPA observed facility first aid kit. LPA requested to review the facility disaster drill log. LN stated the last drill conducted was on November 2023. LN stated he does not have a disaster drill log. LPA reviewed facility records for 3 staff and 3 residents. LPA conducted interviews with 2 staff and 2 residents. LPA requested to review Staff S2's training. LN stated S2 has not completed any training yet. LN stated he does not have any documentation of training for S2 either. LN stated S2 has been working at the facility since June 1st, 2024. LPA requested to review resident R1-R3's medications alongside their Centrally stored Medication Log. R1 and R2's Centrally stored Medication log is blank. Resident R3's centrally stored medication log states the latest medication start date is from April 27, 2022. (Photographs taken.) Facility ADM stated she has not updated the residents R1-R3's centrally stored medication log. ADM stated she still needs to fill out the forms and put the medications on the forms for 2024. LPA requested a copy of the following documents to be sent to the Department by June 21, 2024. 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. LIC200, please update (i.e., new phone numbers etc), if necessary. 6. Qualifications of Administrator (Certificate) 7. Please review your facility program for updates (incorporating new laws and/or regulations) 8. Please submit copy of surety bond Deficiencies are being cited during today's visit, see LIC809-D. This report was reviewed with Licensee Vivencio Ignacio and a copy of the signed report was provided. Appeal rights were provided. END OF REPORT Page 2 Out of 2.the state’s words, verbatim · CDSS document, Jun 14, 2024