Giana's Home #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by Isagani Datinguino, Caregiver who was informed of the purpose of the visit. Administrators Xiomara Valencia arrived thereafter. The facility’s fire clearance is approved for six (6) residents age 60 and over, including up to six (6) non-ambulatory residents, of whom one (1) may be bedridden. The facility also holds a hospice waiver for six (6) residents. At the time of inspection, there were six (6) residents in care. Facility Tour & Observations: Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present. Required “Oxygen in Use” signage was posted in visible locations throughout the facility in accordance with safety requirements. Physical Plant The facility is located in a residential neighborhood and is a single-story home consisting of five (5) resident bedrooms, three (3) bathrooms (one of which is designated as a guest bathroom), a living room, family room, kitchen, dining area, and a caregiver corridor near the kitchen and attached garage. An additional caregiver corridor is located near the resident restroom. All bedrooms observed contained the required furnishings, including a bed, mattress, linens, dresser, chair, and adequate lighting. Bathrooms were observed to be clean and equipped with required grab bars in the showers and near the toilets, as well as non-skid mats. Hot water temperatures measured 116.9°F in Restroom (1) (guest restroom), 109.9°F in Restroom (2) (resident restroom), and 114.3°F in the third bathroom. (continued on 809C) Extra linens and towels were available and stored in hallway cabinets. Smoke and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were observed to be fully charged and accessible. No bodies of water were observed on the premises. The backyard contained shaded seating for residents. Passageways and exits were observed to be clear and unobstructed. Food Service Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of food, including at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were stocked. LPA observed that kitchen knives were locked in kitchen drawer. Health-Related Services & Records Five (5) resident files were reviewed. The files contained current required documentation including Admission Agreements, signed consents, Needs and Services Plans, Physician’s Reports documenting TB results and ambulatory status, and Resident Rights acknowledgments. However, LPA observed that Resident 1 (R1) and Resident 4 (R4) were missing physician’s orders authorizing the use of bed rails. A deficiency will be issued. Four (4) residents’ medications were reviewed. Medications were observed to be centrally stored in a locked closet located near the dining and kitchen area. During the medication review, LPA observed that Resident 5 (R5) had several missed evening medications, as evidenced by the medication bubble pack. A deficiency will be issued. Disaster Preparedness Last fire/earthquake drill was conducted on March 3, 2026, with logs available. LIC 610D Emergency Disaster Plan was available and updated. Emergency supplies (water, food, flashlights, batteries, first aid) were observed. Infection Control Plan was updated. Personnel Records & Training Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Xiomara Valencia was valid through February 25, 2027. Insurance Liability insurance was in compliance with an expiration date of May 5, 2026. An exit interview was conducted with the Administrator Xiomara Valencia. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an annual inspection visit on 05/13/2025 and was greeted by Caregiver Isagani Datinguinoo. LPA Ramirez identified herself and explained the purpose of the visit. Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected five (5) resident rooms. Four (4) resident bedrooms contained required furniture, linens and lighting. Resident bedroom#2 does not have a bed at the request of resident#6 (R6). Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 03/25/2025 and 12/01/2024. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply located in pantry. See 809-C Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Shelly Yamashiro 10/06/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) residents over the age of 59 years old. This facility may retain no more than six (6) hospice residents. There was one (1) resident on hospice during time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Ramirez and Christian Gutierrez conducted an unannounced required Annual Inspection visit on 03/05/2024. LPA was met by Administrator Francis Mejia and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which one (1) may be bedridden and has a hospice waiver approved for two (2). LPA OBSERVATIONS: The facility is a single-story dwelling located on a residential street and consists of five (5) resident bedrooms, one (1) staff bedroom, two (2) full bathrooms, one (1) ½ bathroom, kitchen, dining room, living room, attached garage, front yard, and backyard. LPA Ramirez observed auditory devices on entry of door to be operational, sliding door and exits. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to five (5) out of five (5) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located under kitchen sink, to be inaccessible to five (5) out of five (5) residents in care. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 70-degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C for continuation. Resident Rooms 1-5: LPA Ramirez inspected five (5) resident bedrooms and observed four (4) out of the five (5) bedrooms to contain required furnishings, lighting, and linens. Resident bedroom#2 did not contain a bed. Per interview with resident#1 (R1), R1 does not wish to have a bed in their room. R1 is independent and is not conserved. LPA Ramirez will issue Technical Advisory for exception for removal of R1 bed. Bathrooms 1-2 ½ : Water temperature in two (2) ½ resident bathrooms were within 105-120 degrees F. LPAs observed non slip coating in showers. Backyard: Was clean and well maintained. No hazards were observed. Plenty of shade and seating was observed. Garage: Access to garage was observed to be inaccessible to five (5) out of five (5) residents in care. Extra PPE supplies observed in this area. Emergency Drills/Emergency Disaster Plan/First Aid Kit: LPA Ramirez observed Emergency & Disaster Plan (LIC 610E) during inspection. Last fire drills were conducted on 01/05/24. LPAs observed a First Aid kit in medication closet. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. LPA Ramirez observed Administrator’s certificate for Francis C Mejia with an expiration date of 05/22/2024. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the three (3) personnel records reviewed. Resident Records: Five (5) resident files were reviewed. Admissions Agreement, Medical Assessment, Consent Forms, Appraisal and Needs and Services plan, I.D and Emergency Information, TB Test, and Personal Rights Form were observed in resident records. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. No deficiencies were cited during visit. One (1) Technical Advisory was issued. Exit interview was conducted. A copy of this report, LIC 9102 and appeals was provided.the state’s words, verbatim · CDSS document, Apr 4, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.