Floresma Guest Home

Allegation investigated: Staff retained a resident with a stage 4 pressure injury.

On 06/22/2026 at 9:05am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit in order to render investigation findings. LPA met with Myrna Ma (Licensee) and the purpose of the visit was explained. The investigation consisted of the following: On 09/15/2025 the Department obtained copies of the following: staff and resident rosters and the following documents for resident #1 (R1): Identification & Emergency Information, Physician’s Report, Preplacement Appraisal, Appraisal/Needs & Service Plan, Medication Administration Record (MAR), UCI Health records, Hospice of the Valley records, and Hollywood Home Health records. On 09/29/2025, the Department conducted interviews with residents #1, 2, 3, and 4 (R1, R2, R3, R4), on 09/16/2025 and 09/29/2025, the Department conducted interviews with witness #1 (W1), on 10/02/2025, the Department conducted interview with witness #2 (W2), on 10/08/25 the Department conducted interviews with witness # 3 (W3), on 10/30/2025 the Department conducted interviews with witness # 4 (W4),and Staff #1-2 (S1-S2). Substantiated On 11/06/2025 the Department conducted interview with Administrator (A1), and on 11/19/25 The Department conducted interview with witness #5 (W5). On 09/22/2025, a review was conducted of MEND Wound Care wound care records. On 09/29/2026, the Department conducted a review of Home Health Records from Hollywood Home Health. The investigation revealed the following: Allegation: Staff retained a resident with a stage 4 pressure injury. It was alleged that the resident in care developed a Stage 4 sacral pressure injury, multiple pressure injuries, skin tears, and a possible fungal infection while residing at the facility. On September 29, 2025, the Department interviewed Residents R1, R2, R3, and R4 regarding the allegation. Three (3) out of the four (4) residents denied having pressure injuries and reported no concerns related to skin breakdown. One (1) resident reported having a bedsore but was unable to recall whether treatment was being provided. On September 16, 2025, and September 29, 2025, the Department interviewed W1. W1 reported that the resident did not have any pressure injuries upon admission to the facility but had numerous chronic medical conditions and was receiving services from Hollywood Home Health. W1 stated there was never an indication that the facility was neglecting the resident; however, W1 expressed dissatisfaction with the wound care provider's treatment of the resident's wounds. W1 further reported that the facility did not inform them that the resident could no longer remain at the facility if the wound progressed to a prohibited condition. On October 2, 2025, the Department interviewed W2. W2 stated that after reviewing home health nursing notes, W1 became aware that home health personnel had concerns regarding the wound care being provided. W2 further reported that the resident would likely have benefited from a higher level of care and believed the wound observed was consistent with a Stage 4 pressure injury despite being treated primarily with topical medication. On October 8, 2025, the Department interviewed W3. W3 reported that the resident had previously been hospitalized in January 2025 and, at that time, a Stage 3 sacrococcygeal pressure injury had been identified. W3 stated that appropriate treatment and preventative measures following the hospitalization may have prevented further deterioration of the wound. Throughout July and August 2025, the resident developed additional skin impairments, including pressure injuries to the thigh, hip, and calf, multiple skin tears to the upper extremities, and various rashes and wounds. Home health personnel repeatedly instructed facility caregivers on pressure injury prevention, wound care, moisture management, repositioning requirements, and the need to promptly report changes in skin condition. Records further showed that on August 27, 2025, a facility caregiver observed worsening of the resident's wound, photographed the area, and forwarded the images to the Durable Power of Attorney; however, neither the physician nor the home health agency was notified. Home health staff were not made aware of the wound deterioration until a subsequent visit on August 29, 2025. On August 31, 2025, the sacrococcygeal wound was documented as having progressed to a Stage 4 pressure injury. On September 5, 2025, a wound care specialist identified a Stage 4 sacral pressure injury with necrosis and noted that the wound appeared inadequately treated. The specialist ordered repositioning every two hours, 24 hours per day, implementation of a low-air-loss mattress, and moisture-control measures. The records review also revealed that although the facility employed live-in caregivers, staff were routinely off duty between 7:00 p.m. and 7:00 a.m., resulting in limited overnight repositioning and incontinence care. Additionally, there was no documentation demonstrating that the facility notified the resident's primary care physician regarding the resident's noncompliance with repositioning and offloading recommendations or the home health agency's failure to provide a low-air-loss mattress. On September 9, 2025, the resident was transferred to the hospital due to shortness of breath and was admitted with sepsis and pleural effusion. Hospital wound assessments documented a Stage 4 sacrococcygeal pressure injury; Stage 3 pressure injuries involving the buttocks, hips, and left lower leg; full-thickness wounds beneath both breasts; and multiple skin tears to the upper extremities. The resident underwent surgical debridement, received intravenous antibiotics for sepsis and a positive sacral wound culture, and was subsequently discharged to Kindred Hospital on September 19, 2025. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiencies were observed, and citation issued (ref. LIC 9099D). *Immediate Civil Penalty issued* ECP: At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(f) For a violation that the department determines constitutes physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section 15610.67 of the Welfare and Institutions Code, to a resident, the civil penalty shall be ten thousand dollars ($10,000). Exit interview conducted with Myrna Ma (Licensee), appeal rights reviewed and a copy of this report was provided. On October 30, 2025, the Department interviewed W4. W4 reported being unaware that Stage 3 and Stage 4 pressure injuries constitute prohibited conditions in a licensed residential care facility. W4 stated that the resident's pressure injury may have worsened as a result of prolonged positioning overnight and indicated that the wound deterioration may have been addressed sooner had facility staff reported the observed changes in the wound on August 27, 2025. Also on October 30, 2025, the Department interviewed Staff S2 (S2) and Staff 3 (S3). Both staff members reported that the resident had no pressure injuries upon admission to the facility and was receiving wound care services from a nurse who was later replaced due to worsening wound conditions. Both staff members stated that they repositioned the resident every two hours, utilizing wedges as directed by home health; however, repositioning occurred only during waking hours. One staff member acknowledged being unaware of the stage at which a pressure injury becomes a prohibited condition. On November 6, 2025, the Department interviewed A1. A1 stated that they recommended W1 change home health providers because the nurse was treating the wound primarily with antibiotic ointment. A1 further reported that facility caregivers communicated wound-related concerns directly to W1, who was in communication with the home health agency. A1 also stated they were unaware that Stage 3 and Stage 4 pressure injuries are considered prohibited conditions in a licensed facility. On November 19, 2025, the Department interviewed W5. W5 reported that a family member previously resided at the facility and developed a Stage 4 pressure injury while receiving hospice or palliative care services. W5 stated that concerns regarding the quality of care provided at the facility ultimately resulted in the family member's relocation. The Department conducted a review of facility, hospital, home health, and wound care records. Records revealed that the resident was admitted to the facility in November 2024 with a history of a brain abscess resulting in right-sided weakness and liver cirrhosis causing elevated ammonia levels. Due to these conditions, the resident was bedbound and required total assistance with activities of daily living. Documentation indicated that following a hospitalization in January 2025, the resident returned to the facility with a Stage 2 pressure injury and ongoing home health services. Despite wound care interventions, caregiver education, and repeated instructions to reposition the resident every one to two hours, the wound progressively deteriorated. By May 2025, the pressure injury had advanced to Stage 3. In June 2025, records documented a Stage 3 sacrococcygeal pressure injury, with contributing factors identified as immobility, incontinence, and encephalopathy. On 11/06/2025 The Department conducted interview with Administrator (A1), and on 11/19/25 The Department conducted interview with witness #5 (W5). On 9/22/2025 conducted a review of MEND Wound Care the wound care records. On 09/29/25 The Department conducted a review of Home Health Records from Hollywood Home Health. The investigation revealed the following: Allegation 1: Staff does not maintain resident’s hygiene. It was alleged that a resident was admitted to the hospital appearing unbathed and unkept, with poor oral hygiene, multiple pressure wounds, skin tears under both arms, and possible fungal infection, and that concerns were raised regarding whether staff were maintaining the resident’s hygiene. On 06/22/2026 at 9:15am, the Department interviewed A1. A1 denied the allegation and stated residents are bathed three times per week and grooming/oral care is provided daily. A1 denied receiving any reports that the resident appeared unbathed or unkept and denied receiving concerns about refusal of hygiene care. A1 stated there was no documentation showing when hygiene care was last provided for R1. A1 were aware of a bedsore on the R1's lower back but denied receiving any reports that hygiene care was not being maintained. On 06/22/2026 between 9:25am – 9:40am, the Department interviewed 2 staff regarding the allegation. 2 out of 2 staff denied the allegation. Both staff reported assisting the resident with hygiene care and stated home health provided bathing. Both staff stated R1 occasionally refused hygiene care but not consistently. Both staff denied observing the resident appearing unbathed or unkept. Staff reported observing skin issues but stated these concerns were reported to R1's family member. On 06/22/2026 between 9:56am – 10:05am, the Department interviewed 3 residents with R3, R5 and R6. 3 out of 3 residents denied the allegation. Residents reported staff assist with bathing, grooming, and oral care when needed, staff check on them regularly, and they had not observed residents appearing unbathed or unkept. One resident (R2) declined to be interviewed regarding the allegation at the time. R1 & R4 were unable to be interviewed due to no longer residing at the facility and current locations are unknown of where those residents currently reside. On 06/22/2026 between the hours of 11:30am - 11:45am, the Department conducted a records review and observed the following: For Resident 1 (R1), the LIC 603 Preplacement Appraisal and LIC 625 Appraisal/ Needs and Service Plans forms were not incomplete and not filled out. Also there is not any other documentation outlining the hygiene schedule or plan for R1. Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted with Myrna Ma (Licensee), appeal rights reviewed and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 22, 2026 · control 11-AS-20250910151908

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jun 23, 2026

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by: Based on interviews and records review facility staff failed to reposition R1 as required by residents Home Health which resulted in the R1 developing a stage 4 pressure injury. This poses an immediate health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 22, 2026

Plan of correction: Licensee shall ensure all staff receiving training on personal rights, provisions for providing care and supervision and resident care plans. License shall submit proof of training by POC due date. Email proof to LPA Brown at Zina.Brown@dss.ca.gov An immediate $500 civil penalty assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jun 23, 2026

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on records review and interviews conducted the facility failed to request an exception from Licensing when R1 developed a Stage 4 pressure injury, which is a prohibited health condition. This poses an immediate health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 22, 2026

Plan of correction: Licensee shall ensure staff receive training on prohibited health conditions and submit proof of the training to the department by POC due date. Email proof to LPA Brown at Zina.Brown@dss.ca.gov

Type of visit: Case Management - Deficiencies

On 06/22/2026 at 12:00pm, the Department conducted an unannounced case management deficiencies at the facility listed above. Licensing Program Analyst (LPA) Zina Brown met with Myrna Ma (Licensee) and explained the purpose of the visit. During the complaint investigation for 11-AS-20250910151908, the Department observed the following: On 09/15/2026, upon the Department conducting the initial complaint investigation visit, LPA observed and obtained incomplete documentation that was not filled out such LIC 603 Preplacement Appraisal, LIC 625 Appraisal/ Needs and Service Plans and Home Health Care Plan for Resident 1 (R1). On 06/22/2026, during the subsequent complaint investigation visit for 11-AS-20250910151908, the Department observed 1 employee such as Staff 1 (S1) not being associated to the facility at the time of unannounced complaint investigation. As a result, civil penalties are being assessed and a deficiency is being cited for 87355(e)(2) Criminal Record Clearance under California Code of Regulation Title 22, Division 6, Chapter 8 are being cited on the LIC 809-D. Exit interview conducted with Myrna Ma (Licensee) and a copy of this report was provided with appeal rightsthe state’s words, verbatim · CDSS document, Jun 22, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jun 23, 2026

Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department This requirement was not met as evidenced by: Based on observation and interview, S1 Nancy Diocampos were not associated to the facility as the time of unannounced complaint investigation which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 22, 2026

Plan of correction: The facility shall associate S1 Nancy Diocampos in Guardian and submit proof of update via email at zina.brown@dss.ca.gov by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Jul 6, 2026

(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. This requirement was not met as evidenced by: Based on observation, the facility had incomplete documentation such as LIC 603 Preplacement Appraisal, LIC 625 Appraisal/ Needs and Service Plans and Home Health Care Plan for Resident (R1) which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 22, 2026

Plan of correction: The facility shall submit proof of updated resident records for all residents such as LIC 601, LIC 603, LIC 613, LIC 625 and all other required documentation per title 22 regulations via email at zina.brown@dss.ca.gov by POC due date.

Type of visit: Required - 1 Year

On 04/17/26, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Arturo Yangco as the purpose of the visit was explained. The facility is licensed to serve (6) non ambulatory residents 60 and above, there is an approved hospice waiver approved for (4). Liability Insurance is active (exp: on 4/29/2026), facility fees are due (Balance: $495, due date: 4/20/26 Pin: 105407). The facility is a single-story structure located in a residential neighborhood and consists of the following: (6) bedroom of which (4) are resident bedrooms, and (2) are staff bedrooms, (1) resident bathroom, (1) staff bathroom, a living room, dining room, kitchen, an attached garage with washer and dryer/ storage area, and a backyard with table and chairs. Please note that the staff have there own separate kitchen and living room. All resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards. LPA conducted a records review of 3 staff records, 3 client records, and 3 medication administration records, Medications were centrally stored and properly locked. A first aid kit was checked and fully stocked, 2 fire extinguishers fully charged, carbon monoxide and smoke detectors are interconnected and operational. Deficiencies cited on 809 D. Exit interview conducted, appeal rights explained, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2026

Type of visit: Required - 1 Year

On May 2, 2025, Licensing Program Analyst (LPA), Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA Lee met with Myrna Ma and the purpose of today’s visit was explained. The facility is licensed to serve six (6) residents, all of which (6) may be non-ambulatory with a hospice waiver approved for four (4) aged 60+ years. The Annual Licensing Fees are current. Physical Plant/Structure : The one-story residential home consists of four (4) resident bedrooms, one (1) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. The facility is clean, sanitary, and in good repair. Licensee accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Page 1 of 2 Bedrooms: LPA inspected all 4 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathrooms: Resident bathroom was checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid material was in place, hot water temperature properly measured 114 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common Rooms Common areas were clean and clear of hazards, doorways were free of obstructions. First Aid kit was available. 3 fire fully charged fire extinguishers were observed in the kitchen area, the living room area. Staff tested smoke/carbon monoxide detectors they were operational. Required Postings: LPA observed all required documents posted throughout the facility. Page 2 of 3 Kitchen: LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Knives and toxins were kept locked and inaccessible to residents in care. Safety: LPA observed 3 fully charged fire extinguishers . Emergency disaster plan updated 5/2/25. Smoke detectors/Carbon monoxide detector tested and is operational. File Review: LPA reviewed ( 5 ) resident files and found that ( 5 ) out of (5 ) had the required documents. LPA reviewed ( 4 ) staff fields and found that ( 3 ) out (4) had the required documents, training, and certifications. The 3 out of 4 needed to update CPR/First Aid. Medications LPA observed all centrally stored medications secured. All medications were observed in their original packaging. LPA reviewed a copy of the facility’s Liability Insurance which expires on 4/29/2026 During today’s visit there were no deficiencies issued. There was Technical Advisory note issued. See LIC 9102. An exit interview was conducted with Myrna Ma and a copy of this report was provided. Page 3 of 3the state’s words, verbatim · CDSS document, May 2, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff do not provide adequate food service for a resident Staff do not meet a resident's hygiene needs Residents needs are not being met due to lack staff

On March 13, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted a subsequent complaint visit to gather information regarding the above allegation(s) and to deliver findings. LPA Lee met with Myrna Ma, Licensee and explained the reason for the visit. The investigation consisted of the following: On February 19, 2025 (the initial 10-day), LPA Lee and Myrna Ma toured the facility inside and out. LPA reviewed and requested, the following: staff roster (dated 4/26/24 ), resident's roster (dated 2/19/25 ), Physician's Report for Residential Care for the Elderly (RCFE) for R1 dated (5/29/24) and facility menu. LPA reviewed Admission Agreement for R1(date signed 5/27/24 ), reviewed resident files ( R1-R5). LPA Lee inspected facility's food supply, interviewed (3) residents (R1,R3,R4), and Licensee (A1). On March 13 2025 (subsequent visit), LPA interviewed (2) staff (S1-S2) and 1 Resident (R2). LPA was unable to interview R5 due to R5’s non-verbal status. Page 1 of 3 Unsubstantiated Investigation revealed the following: Allegation: Staff do not provide adequate food service for a resident. The detail of the complaint alleges that the food served is not of good quality; it was reported that a dinner meal consisted of ramen noodles with sliced hot dogs inside. LPA interviewed facility Administrator (A1) who denied allegation and stated that nutritious food is always served to the residents and there was never a time when ramen noodles with sliced hot dogs served. On 2/19/24, LPA interviewed residents and of the residents interviewed, (3) out of (4) stated that they are served nutritious food (2) out of (4) stated that they were never served ramen noodles with hot dogs slices inside; (1) out of (4) stated that she has been served ramen noodles before and hot dogs before, but never the combination of ramen with hot dogs slices inside. On 3/13/25, LPA interviewed 2 staff and of those interviewed (2) out of (2) denied allegation and stated that food served is of good quality. (2) out of (2) stated that they have never served a resident ramen noodle with hot dog slices inside. On 2/19/25, LPA observed the facility’s food supply and found that there was a 2-day supply of perishable food and 7-day supply of non-perishable food in the facility. Additionally, there were a variety of fruit and vegetables on hand. On 2/19/25, LPA obtained/reviewed a copy of facility menu and found that hot dogs and ramen noodles were not listed on the menu. Based on the information gathered, there is insufficient evidence to support the stated allegation. Page 2 of 3 Allegation: Staff do not meet a resident's hygiene needs The detail of the complaint alleges that grooming and hygiene services (including bathing female residents) are being provided by male staff when there is a preference for a female staff. On 2/19/2025 LPA interviewed A1 who denied allegation. However, she did state that a male staff (S2) provides grooming/hygiene services when needed. A1 further stated that she asks if they are comfortable with a staff of the opposite sex to bath/shower them and if there is an issue with it, then they will accommodate the residents' preference. On 2/19/25, LPA interviewed residents and asked how comfortable are they with a male staff bathing them. Of those interviewed, (2) out of (4) stated that they have no problem with a male staff bathing them because that person is respectful of them. (1) out of (4) stated that she is okay with it, but she would prefer a family member help her in that area. On 3/13/25, LPA interviewed (1) resident and she stated that she is okay with the male staff bathing her. On 3/13/25, LPA interviewed staff and (2) out of (2) stated that there has been no complaints that residents are uncomfortable with a staff of the opposite sex bathing them. Additionally staff added that home health or hospice typically come out to provide shower/bathing service, therefore, they do it on occasion. Based on the information gathered, there is insufficient evidence to support the stated allegation. Allegation: Residents needs are not being met due to lack staff On 2/19/25 and 3/13/25, LPA observed that there where enough staff tending to the needs the residents in care (2 staff and Administrator present at time of LPA’s visit). LPA obtained/reviewed staff schedule which shows ample staff available to care for the residents. During interviews with residents (4) out of (4) state that their needs are being met. Based on the information gathered, there is insufficient evidence to support the stated allegation. Although the allegations above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation are UNSUBSTANTIATED. No deficiencies were cited for the above allegations. Exit interview was conducted. A copy of this report was provided to Myrna Ma Administrator. Page 3 of 3the state’s words, verbatim · CDSS document, Mar 13, 2025 · control 11-AS-20250214160338

Type of visit: Required - 1 Year

On 04/19/24 at 12:20 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Licensee Myrna Ma. The facility is licensed to serve six (6) residents, all of which (6) may be non-ambulatory with a hospice waiver approved for four (4) aged 60+ years. The one-story residential home consists of four (4) resident bedrooms, one (1) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. The facility is clean, sanitary, and in good repair. Licensee accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathroom were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 109.5F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. Two fire extinguishers was observed in the kitchen area. Staff tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. Continue to LIC809-C. 5 staff records were reviewed, 5 out of 5 staff records had required criminal record clearances or criminal record exemptions. Two staff interviews were conducted. 4 resident records were reviewed and, 4 out of 4 client records had medical assessments. Two residents’ medication was reviewed. Two residents were interviewed. Deficiencies are being cited based on record review in accordance with the California Code of Regulations, Title 22, see LIC809D. LPA Cloyd did not observe Health Screening Reports (LIC 503) for Staff #1 and Staff #5. Staff #1 was on site. An exit interview was conducted, technical assistance provided, Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and left with Caregiver Arturo Yangco.the state’s words, verbatim · CDSS document, Apr 19, 2024

The state marks this report as 18 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.