Family House

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 8/10/26 at approximately 3:05pm, and met with Licensee/Administrator Estelita (Lita) Guzman. LPA observed the Administrator, and three (3) caregivers working at the time of arrival. There are currently seven (7) residents in care. Fire clearance is approved for nine (9) non-ambulatory, of which two (2) may be bedridden. Resident rooms are all private. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has a required infection control plan. The facility has an emergency disaster plan as required. LPA toured the facility with the Administrator Estelita. All exit doors had auditory alarms. All exits doors and pathways were free and clear of obstruction. The facility had sufficient lighting in hallways, common areas, bathrooms, and resident rooms. The home was observed to be clean and orderly. The bathrooms had grab bars and non-slip mats/non-slip flooring for the showers for resident use. The home had sufficient cleaning/disinfectant supplies, paper products, linens, furnishings, and personal protective equipment (PPE) supplies. LPA is requesting the following documents be updated and submitted by 9/10/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E- Emergency Disaster Plan (review and update as needed/required- sign/date plan & submit) Infection Control Plan (review and update as needed/required- sign/date plan & submit) LIC400- Handling of Client Cash Resources (all facilities complete this form Copy of Surety Bond -if handling cash Current Liability Insurance Resident Roster Copy of current Administrator Certificate The LPA will complete this annual at a later date.the state’s words, verbatim · CDSS document, Aug 10, 2026

Allegation investigated: Resident's medication was not centrally stored as required Medication was not provided to the resident as prescribed Resident's room had a stained carpet upon move-in

Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 12/29/2025 at approximately 10:00am, and met with Administartor Lita Guzman. LPA observed three caregivers on duty during the inspection. Reporting party alleges a "resident's medication was not centrally stored as required, medication was not provided to the resident as prescibed, and resident's room had a stained carpet upon move-in." The LPA reviewed resident records, facility records, conducted interviews with staff, and other related parties. The investigation revealed that R1's prescribed liquid medication had been left out on resident's dresser in their room; This medication was not centrally stored and locked up, as required, this deficiency will be cited, 87465(h)(2) Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication, see LIC9099D. Continued on LIC9099C.. Substantiated Per LPA's review of medication records, the MAR sheet, it was identified that on 10/9 there were two medications that were not provided to R1 as prescribed; One medication is provided once in the am, the other medication is provided twice a day, in the am and in the pm. In review of medication records, there was no information documented as to why these medications were not provided to R1. The Administrator could not provide a reason why the Mar was blank on 10/9 for these two medications R1 didn't receive. This deficiency will be cited, 87465(a)(4) Incidental Medical and Dental Care - A plan for incidental medical and dental care shall be developed by each facility.The licensee shall assist residents with self-administered medications as needed, see LIC9099D. Per review of information obtained from interviews with the Administrator, and other parties, and tour of some facility resident rooms, the facility does have light colored carpet with some stains in different areas that are very visible. Administrator stated the carpet is older and they do clean it, but they will see about replacing the rug because they can see the stains the LPA was seeing/pointing out. LPA obtained some photos. These deficiency will be cited, 87303(a) Maintenance and Operation- The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services, see LIC9099D. Per investigation, conducted interviews, review of facility records, and review of resident records, there was sufficient information obtained to support that the alleged violations occurred. Based on record reviews, and interviews during this investigation, the allegations of "resident's medication was not centrally stored as required, medication was not provided to the resident as prescribed, and resident's room had a stained carpet upon move-in." is substantiated. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Exit interview was conducted with Emilita Guzman, Administrator. Appeal Rights and report provided to the Administrator. Facility had a sufficient supply of food, a variety of food items, including fruits and vegetables/greens, for resident meals. There was insufficient information obtained in the investigation to support that the allegations "violation of residents personal rights, responsible party was not notified of resident's fall in a timely manner, and meals provided to the residents' lack nutritious items, like greens, vegetables and/or salad." had occurred. The LPA discussed personal rights of residents in care, incidents/reporting incidents, and food service regulations, with the Administrator during the inspection. Based on record reviews, interviews conducted, and information obtained, there is no evidence to support the violations occurred. The allegations are UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited. Exit interview was conducted with Emilita Guzman, Administrator.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 21-AS-20251224133925

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 30, 2025

87465(h)(2) Incidental Medical and Dental Care- The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: R1's prescribed liquid medication had been left out on resident's dresser in their room; This medication was not centrally stored and locked up, as required, This is a risk to the health & safety of residents' in care.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee/Administrator to ensure that all resident medications are centrally stored as required. Hold an in-service with all staff to review medication policies of the facility. Submit proof of training by 1/8/26. Submit a plan regarding future compliance with this regulation, and plan of correction by 12/30/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Dec 30, 2025

Incidental Medical and Dental Care - A plan for incidental medical and dental care shall be developed by each facility. The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Per LPA's review of medication records, the MAR sheet, it was identified that on 10/9 there were two medications that were not provided to R1 as prescribed; One medication is provided once in the am, the other medication is provided twice a day, in the am and in the pm. Administrator could not provide any information why these medications were not provided. This is a risk to residents' health & safety.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee/Administrator to ensure that all resident medications are provided to residents' as required. Hold an in-service with all staff to review medication policies of the facility. Submit proof of training by 1/8/26. Submit a plan regarding future compliance with this regulation, and plan of correction by 12/30/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 19, 2026

87303(a) Maintenance and Operation- The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services. This requirement was not met as evidenced by: tour of some facility resident rooms, the facility does have light colored carpet with some stains in different areas that are very visible. Administrator stated the carpet is older and they do clean it, but they will see about replacing the rug because they can see the stains the LPA was seeing/pointing out. This is a risk to residents' personal rights.the state’s words, verbatim · CDSS document, Dec 29, 2025

Plan of correction: Licensee/Administrator to ensure the facility carpet is maintained in a clean manner, not dirty and stained, and/or replace the rug if needed. Submit how the facility will ensure compliance with this reguation, how this deficiency was corrected, and how it will be maintained. POC due 1/19/26.

Allegation investigated: Staff are violating the personal rights of residents' in care Staff did not ensure residents' had the ability to request assistance when needed Staff did not provide timely incontinence care to resident Staff did not provide adequate supervision for residents Staff did not report incidents involving resident as required Staff did not ensure food served to residents was free from foreign objects Staff did not ensure resident received adequate nutrition. Staff did not provide medication to the resident as prescribed

LPA Dina Alviso conducted a complaint inspection, on 11/20/25 at approximately 1:35pm, and met with Rhonel Recinto, Lead Caregiver. LPA observed a second caregiver on duty, Marion Abayata. Reporting party alleged "staff are violating the personal rights of residents' in care, staff did not ensure residents' had the ability to request assistance when needed, staff did not provide timely incontinence care to resident, staff did not provide adequate supervision for residents, staff did not report incidents involving resident as required, staff did not ensure food served to residents was free from foreign objects, staff did not ensure resident received adequate nutrition, and staff did not provide medication to the resident as prescribed. The LPA reviewed resident records, and staff records; The LPA requested copies of documents. The Lead caregiver Rhonel provided LPA with all requested copies. The Administrator provided additional documents as requested by the LPA after initial facility visit. The LPA conducted interviews with staff, and other related parties regarding the allegations reported. Continued on LIC9099C... Unsubstantiated The Administrator provided additional documents as requested by the LPA after initial facility visit. The LPA conducted interviews with staff, and other related parties. The investigation revealed that per staff interviews, incontinent residents are checked every two to three hours or more often as needed, to be cleaned and changed. Incontinent care is provided through the late night and noc shift hours, at 9pm/10pm, 12am, 3am, 6am, and outside of these hours if resident needs incontinent care. The facility has a sufficient supply of food to provide meals, drinks, and snacks to all residents' in care as needed/required. Per interviews with other related parties, the food provided is good, and in sufficient amounts. If residents don't want the served meal, the staff offer another type of meal that the resident chooses to eat. Per staff interviews, the food is never a problem here, there is a lot of food to provide all meals and snacks, drinks and coffee, including deserts. Per interviews, food is served with no objects of any kind that are not part of the meal, no foreign objects that staff state they were aware of. All resident are provided the call buttons so they may ring to staff for assistance needs. There were no call bells observed to be out of reach to residents in care. Staff stated they respond to residents' calls for assistance, and this is in the night and noc shifts as well as during the day. Per review of records, none of the residents in care are documented as a one to one care need, no care plans state level of care as one to one. The staff care for multiple residents at the same time, providing care assistance. No information was able to be obtained to support medication violations had occurred. There were no incidents that the LPA could obtain sufficient information to support violations had occurred. There were no specific identified dates and/or time frame of staff having handled the resident in a rough manner and/or hitting of a resident in care; No information was obtained to support resident personal rights are violated. The LPA reviewed with staff the regulations regarding resident personal rights, food service, emergency call bells/buttons, incontinent care, medication assistance, reporting requirements, caregiver duties/training, and ensuring personal privacy of all residents' in care. Staff stated their understanding to the LPA. Per investigation, there was no information obtained to support violations occurred regarding reported allegations of "staff are violating the personal rights of residents' in care, staff did not ensure residents' had the ability to request assistance when needed, staff did not provide timely incontinence care to resident, staff did not provide adequate supervision for residents, staff did not report incidents involving resident as required, staff did not ensure food served to residents was free from foreign objects, staff did not ensure resident received adequate nutrition, and staff did not provide medication to the resident as prescribed. Based on record reviews, interviews conducted, and information obtained, there is no evidence to support the violations occurred. The allegations are UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies cited. Report copy left with Rhonel Recinto. Exit interview was conducted with Lead Caregiver, Rhonel Recinto.the state’s words, verbatim · CDSS document, Nov 20, 2025 · control 21-AS-20251008144720

Type of visit: Case Management - Other

LPA Dina Alviso conducted a case management inspection, on 10/15/25 at approximately 4:30pm, and met with Rhonel Recinto, Lead Caregiver .LPA observed two other caregivers on duty during the inspection. Administrator Estelta Guzman was unable to arrive to the facility to meet with the LPA. This case management is being conducted due to a deficiency observed during the complaint inspection of earlier today. The deficiency observed is unrelated to the complaint investigation . LPA had observed a staff cooking the dinner meal on the stove. While at a small table in the kitchen, the LPA called out to staff Rhonell and told them that there is no staff here in the kitchen supervising over the stove that is on and the pot of corn boiling on the stove. Caregiver Rohnell went to the stove and turned the burner off, and called out to caregiver Mildred, who was cooking the meal. There are residents' in care that are at risk if they have access to the hot stove, and pot of boiling water on a hot stove.This is a health and safety risk to residents' in care, This deficiency will be cited, 87307(e )(1)Personal Accommodations and Services- The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices, see LIC809D. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency (s) and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided. Exit interview conducted with Rohnell Recinto, Lead Caregiver.the state’s words, verbatim · CDSS document, Oct 15, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(e)(1) · Plan of correction due date: Oct 16, 2025

87307(e )(1)Personal Accommodations and Services- The licensee shall supervise residents as needed and as determined by the resident's appraisal pursuant to Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, when residents are in proximity to or when there is use of the following items: Ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices. LPA called out to staff Rhonell and told them that there is no staff here in the kitchen supervising the stove that is on, and the pot of corn boiling on the stove. Caregiver Rohnell went to the stove and turned the burner off, and called out to caregiver Mildred, who was cooking the meal. There are residents' in care that are at risk if they have access to the hot stove, and pot of boiling water on a hot stove.This is an immediate health and safety risk to residents' in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Licensee/Administrator to ensure staff are in-serviced on complaince with regulation in supervising items such as ranges, ovens, heaters, fireplaces, wood stoves, inserts, and other heating devices, that are a risk to certain residents in care, per medical assessments, and behaviors. Submit proof of training to the Department by 10/22/25; Submit plan of correction (POC) by 10/16/25.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 7/1/25 at approximately 2:20pm, and met with Licensee/Administrator Estelita Guzman. LPA observed the Administrator, and four (4) caregivers working at the time of arrival. There are currently seven (7) residents in care. Fire clearance is approved for nine (9) non-ambulatory, of which two (2) may be bedridden. Facility has nine (9) private resident rooms. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has a required infection control plan. The facility has an emergency disaster plan as required. LPA reviewed five (5) resident files; Resident files were complete. LPA reviewed five (5) staff files. All staff have first aid and CPR certification. LPA reviewed staff training. LPA toured the facility with the Administrator. Facility was clean and orderly during the inspection. Hot water was measured at 109.8 degrees Fahrenheit. All exits had auditory alarms. All exits were clear of obstruction. All facility walkways and ramps were free and clear of obstruction. All smoke alarms and carbon monoxide detectors were working properly during the inspection.Facility had sufficient lighting in resident rooms, bathrooms, hallways, and all common areas for residents in care. Bathrooms had grab bars, and mats in all showers for resident use. Continued on LIC809C... Continued from LIC809, dated 7/1/25. The backyard deck has patio furnishings and shade umbrellas for resident use. There is a front yard ramp and two backyard ramps for resident use, and to use in the event of an emergency. Sufficient food supply was observed by the LPA. Sufficient supply of hygiene products, paper products, linens, cleaners/disinfectants, and personal protective equipment (PPE). Facility had emergency supplies to meet the "72 hour Shelter In Place requirements". LPA is requesting the following documents be updated and submitted by 8/1/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate Emergency Disaster Plan- Update as required/if changes-submit copy if any updates. Infection Control Plan- Update as required/if changes-submit copy if any updates. The following deficiencies were observed during the inspection: LPA observed refrigerated medication in a small, unlocked refrigerator in the kitchen; LPA observed that the two medication bottles were left unlocked and accessible to residents in care. This deficiency will be cited, 87465(h)(2 Incidental Medical and Dental, see LIC809D. Per LPA record reviews, Licensee lacked proof of conducting required quarterly drills per health & Safety Code. This deficiency will be cited, HSC1569.695(a)(2) Quarterly Emergency Disaster Drills, see LIC809D. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency (s) and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided. Exit interview conducted with the Administrator, Estelita Guzman.the state’s words, verbatim · CDSS document, Jul 1, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs), Alviso and Loera, conducted a continued annual inspection, on 8/5/24 at approximately 2:40pm, and met with Administrator/Licensee Estelita Guzman. Annual was started on 8/1/24, see LIC809. Fire clearance is approved for nine (9) non-ambulatory, of which two (2) may be bedridden. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has a required infection control plan. The facility has an emergency disaster plan as required. Fire extinguishers were serviced and tagged as required. LPAs reviewed six (6) resident files. LPAs reviewed four (4) staff files. The following deficiencies were identified during file reviews: Resident's (R2) medical assessment was not complete, many sections were left blank on many pages of the assessment. A note on a page of the LIC602 medical assessment referred the reader to see attached "problem list and medication list." These items were not observed attached to the medical assessment. Administrator couldn't provide the medical assessment documents to the LPAs for review. This deficiency will be cited, 87458(a) Medical Assessment- Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment, see LIC809D. Continued on LIC809C... Per file reviews, and staff interviews, Staff (S2) lacks a health screening chest x-ray or an intradermal test as required. S2 has been working for approximately six (6) months, per interviews. This deficiency will be cited, 87411(f) Personnel Requirements – General- All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure, see LIC809D. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided. Exit interview conducted with the Administrator, Estelita Guzman.the state’s words, verbatim · CDSS document, Aug 5, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 8/1/24 at approximately 2:30pm, and met with Licensee/Administrator Estelita Guzman. LPA observed the Administrator, and two (2) caregivers working at the time of arrival. There are currently eight (8) residents in care. There are nine (9) private resident rooms. Fire clearance is approved for nine (9) non-ambulatory, of which two (2) may be bedridden. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has a required infection control plan. The facility has an emergency disaster plan as required. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. All required postings were observed to be up on the walls as required. LPAs toured the facility with the Administrator. All exits were free and clear of obstruction. All exits had auditory alarms. There was a sufficient food supply. There was a sufficient supply of linens, paper products, cleaners/disinfectants, hygiene supplies, and personal protective equipment (PPE). The facility was clean and orderly. Facility had sufficient furnishings for resident use. Facility had sufficient lighting in resident rooms, bathrooms, hallways, and all common areas for residents in care. Bathrooms had grab bars, and mats in all showers for resident use. The backyard deck has patio furnishings and shade umbrellas for resident use. There is a front yard ramp and two backyard ramps for resident use, and to use in the event of an emergency. The annual inspection will be continued at a later date.the state’s words, verbatim · CDSS document, Aug 1, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Alviso conducted a case management on 11/21/23 at approximately 9:15am, and met with caregivers Rhonel Recinto and Mary Grace Bustas. Case management is being conducted as the Licensee is requesting an increase in capacity, from six (6) to nine (9) residents. There are currently six (6) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Fire clearance is approved for nine (9) non-ambulatory, which includes two (2) bedridden approval, effective 10/17/23. All exits were free and clear of obstruction. Fire extinguishers, (2), were serviced and tagged as required. LPA observed fifteen (15) smoke alarms, including carbon monoxide detector. All exit doors had auditory alarms, and the alarms were working properly during the inspection. The front of the facility entry has a large cement porch area with a ramp for resident use, and across from the ramp is an open area with two steps off of the porch, there is no self latching gate at this area. Licensee will continue to ensure residents accessing the front of the facility's cement porch area are supervised as needed and required, due to the open area with steps. This is a health and safety concern, Licensee has stated a self latching gate will be installed due to the safety concerns. Licensee to notify Licensing Department when this is complete. Licensee to ensure the facility sketch is updated and submitted to the Licensing office, by 11/22/23; LPA will notify the local Fire Department to come out and reinspect due to the changes, since last visit of 10/19/23, to the facility's outside physical plant. The facility's increase in capacity, from six (6) to nine (9) residents is approved today, 11/21/23. No deficiencies cited today.the state’s words, verbatim · CDSS document, Nov 21, 2023