Good Samaritan Elderly Home II

Type of visit: Required - 1 Year

On January 07, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator, Meldy A. Carreon. Facility file review conducted at the Regional Office and additional records were requested and reviewed on site. Facility is licensed for six Elderly Adults and is currently operating at three (740). LPA Mixson toured the facility along with the Administrator, Meldy Carreon and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The facility is a single-story home located at 12145 Westerly Trail, Moreno Valley, CA.92557. Physical Plant: The facility phone number is (951) 259-4762 and it is operable. LPA Mixson observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22, at the time of this visit. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations, and is logged. The bathrooms were clean, and appliances were operating appropriately currently. The home is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the PUB 475. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Administrator informed LPA there were safety lights for night throughout the facility. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. Care & Supervision/Administration: Adequate staff are present for the supervision of residents in care. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator possesses a current administrator’s certificate with an expiration date of 05/31/2026. Records Reviewed and Resident/Staff Files: LPA reviewed staff files and reviewed the facility's staff schedule. The staff files reviewed had current criminal clearance and updated training along with First Aid Certification. The resident files reviewed possessed required paperwork at the time of this visit. Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards. Administrator indicated fires drills are conducted monthly. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures at the time of this visit. There were no TA deficiencies observed or cited per Title 22, Division 6 of the California Code of Regulations at this time. An exit interview was conducted where a copy of this report was discussed and given to Administrator, Meldy A. Carreon.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Direct Support Caregiver Mimichaela Carpio who was informed of the purpose of the visit. The facility has a fire clearance for six (6) Non-Ambulatory and a Hospice waiver approved for two (2). LPA toured the facility with Direct Support Caregiver and reviewed records. During the tour, LPA observed the facility is made up of a one (1) story home with three (3) resident bedrooms, one (1) staff room, one (1) resident bathroom and one (1) staff bathroom, a living room, dining room, kitchen and attached garage. Facility has a Activity room located next to the dining area where LPA observed activity games, computers and arts and craft. All resident's bedrooms had required furniture and lighting. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is also available for the residents in care. LPA observed a hallway cabinet filled with clean towels, blankets, and linen, available for the residents. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA observed that sharp knives and dish washer supplies are located in a locked kitchen cabinets. Resident's medications are also locked in the kitchen cabinet. LPA toured the garage and observed that there are multiple cabinets that have extra bedding sets and clean linen sheets available for the residents. LPA observed that the garage has the Emergency kits and supplies stored in a cabinet. LPA observed that the laundry room had cleaning solutions, laundry detergent, and disinfectants in a locked cabinet. Direct Support Caregiver Mimichaela tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed two (2) charged fire extinguishers mounted throughout the facility, last serviced on 12/4/24. Exit signs, emergency contact information, resident's personal rights, and complaint information are visibly posted near the entrance and throughout the facility. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: Required - 1 Year

On 1/5/2024, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by caregiver, Mamichaela Carpio who was informed of the purpose of visit. LPA also met with Licensee, Meldy Carreon who was also informed of the purpose of visit. At the time of visit there were 2 staff and 3 residents present. LPA was informed one resident is at the Day Program. LPA toured the facility inside and out with Mamichaela Carpio and Alma Labagala. Tour included: Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the census. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lid. Fridge, freezer, and all need appliances were present and shown to be in working condition and clean. Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 70 degrees Fahrenheit. Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items. Medication: Medications were labeled and stored in separate bins inside of a locked medication cabinet and are distributed according to physician orders. The first aid kit was complete. Continue on LIC809 Continued from LIC809. Bathroom: LPA toured hall bathroom and observed bathroom to be clean and equipped with grab bar and non-skid mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 106 degrees Fahrenheit. Bedroom: LPA toured three #3 out of #3 resident bedrooms and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs, and lighting. Garage: LPA tour the garage and observed garage to be clean. Laundry: Washing machine and dryer are all in good repair and sufficient for the census. Cleaning supplies are stored away in the laundry room, inaccessible to clients. Backyard: LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gates remain unlocked. No bodies of water were observed. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and freezer are large enough to accommodate required perishable food. Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Three #3 staff and #3 residents' records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 5/30/2024. Interview: two staff and three resident were interviewed. No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Meldy Carreon.the state’s words, verbatim · CDSS document, Jan 5, 2024