Good Samaritan Guest Home IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Leonardo Cambio and explained the reason for the visit. Leonard Cambio Administrator's certificate expires on August 9, 2027. Facility is licensed for 6 non-ambulatory residents with a hospice waiver for 1. At this time there are no residents on hospice at the facility. Facility is a single story home with 4 bedrooms (1 is for staff), 2 bathrooms, kitchen, living room, dining room with a fireplace that is screened and a 2 car garage that is used for storage and kept locked. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked in the kitchen pantry. The fire extinguisher in the kitchen is fully charged. Medication is kept locked in the staff room. LPA observed all resident rooms have the required furnishings and bed linens. LPA observed both bathrooms are clean and operational. Hot water measured 105.0 degrees Fahrenheit in both bathrooms. LPA observed the garage is used for storage. LPA and Administrator toured the backyard. There is a storage shed in the backyard. The storage shed is used to store old furniture and supplies. No bodies of water observed in the backyard. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 6 resident records and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. Both staff members are background cleared and associated to the facility. Both staff members have the required annual training and CPR training. Smoke detectors/carbon monoxide detectors tested operational. The last emergency drill was conducted April 3, 2026. LPA inspected the first aid kit. The first aid kit has all the required elements. LPA consulted with Administrator regarding reporting requirements. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 9, 2026

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff. Administrator Susan Cambio was notified of the visit by telephone and arrived later to assist. There are currently five residents in care, none of which are receiving hospice care at this time. LPA observed residents relaxing in the facility's common living areas or in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has three shared bedrooms along with one staff rooms and two shared bathrooms. Bedrooms appear clean and sanitary. No residents are observed using postural supports at the time of the visit. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 112F and 120F in two separate bathrooms equipped with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secured. The two wall-mounted fire extinguishers are charged. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The garage is inaccessible to residents and used for laundry as well as additional storage of food and supplies. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with furniture for resident use. There is one self-latching gate on one side of the property and a double-wide gate on the other side of the property. The routes of egress are free of clutter and obstructions. There are no bodies of water on the premises. Facility does not utilize locked perimeters or delayed egress. LPA reviewed five resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. Oxygen is not currently in use on the premises. There is one resident currently assessed as being bedridden at the time of the visit per their physician report. Resident is however observed in the living room in a recliner and is stated to be able to ambulate with the help of a walker. Facility staff instructed to request an updated form LIC602 accurately reflecting the resident's condition. Resident interviews were conducted or attempted during the visit along with staff interviews. LPA reviewed staff records for two caregivers present during the visit. Present staff members have current CPR certificates on file. Annual training on file. Disaster drills are conducted however no proof of attendance is currently being generated. Consultation provided. Both staff members present are background cleared and associated to the licensed location. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along were provided to a facility representative.the state’s words, verbatim · CDSS document, May 30, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after explaining the purpose of the visit. Facility administrator Leonardo Cambio was notified by telephone and arrived shortly afterwards to assist. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with 3 shared rooms and one staff room in addition to the facility's common living areas and two full bathrooms. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. The backyard has a shaded area and the routes of egress are free of clutter and obstructions. There are currently four residents admitted to the facility with no resident receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Combined smoke and carbon monoxide detectors tested operational. Fire extinguisher present are observed to be fully charged. Medication, sharp items were confirmed to be inaccessible throughout the physical plant, however bleach was observed under the kitchen sink and secured in the garage during the visit. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed four resident files and three staff files. Based on the observations made during today’s inspection, one type A deficiency and two type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations along with four advisory notes provided. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 17, 2024

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.