Guardian Angel Home Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with House Manager, Terry Lacey Continual Administrator's Certification for Lidia Silveira expires 10/04/2026. There are currently 4 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. LPA observed spider webs in corners, and furniture needs dusting. LPA observed chemicals inside garage accessible to residents. Staff 1 does not have required training. Resident 1 does not have updated Needs and services plan. The facilities Plan of Operation does not have a required mention of dementia. The facility residents do not have planned activities. LPA observed a large bed located inside resident common area. Resident 2's medications are not logged into the Centrally Stored Medication record. First aid kit is missing the tweezers. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with House Manager, Terry Lacey, and copy of report left at facilitythe state’s words, verbatim · CDSS document, Jan 28, 2026

Allegation investigated: Staff do not provide adequate supervision resulting in residents falling and sustaining injuries. Staff did not seek medical attention for resident. Staff does not ensure residents are fed. Staff does not ensure resident's showering needs are being met. Staff does not ensure a food menu is available for residents.

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA met with facility House Manager, Terry Lacey and explained the purpose of today's visit. Regarding the allegation Staff do not provide adequate supervision resulting in residents falling and sustaining injuries. Resident 1 did have a bruising but it is not clear how the injury was sustained. 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. Unsubstantiated Regarding the allegation Staff did not seek medical attention for resident. Resident 2 did have what appeared to be a rash. The rash was treated within 48 hours.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. Regarding the allegation Staff does not ensure residents are fed. LPA has witnessed residents being fed on multiple visits to the facility including on 08/08/25, 09/10/25, and 09/12/2025. LPA observed food including meat, fruit and snacks inside the facility refrigerator and pantry. 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. Regarding the allegation Staff does not ensure resident's showering needs are being met. LPA interviewed one facility resident and 3 facility staff who all stated the residents are being showered and they do have a shower schedule. 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. Regarding the allegation Staff does not ensure a food menu is available for residents. LPA did observe a menu available for residents. The facility is very flexible with food provided as residents often request different food meals and food items. 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 facility House Manager Terry Lacey , and copy of report providedthe state’s words, verbatim · CDSS document, Dec 12, 2025 · control 24-AS-20250815103726

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80072(a)(3) · Plan of correction due date: Dec 13, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.The following requirement has not been met as evidenced by: Based on interviews conducted resident 1 slept on the floor despite no documentation in medical assesment., which poses a potential, helth, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Licensee will conduct training on personal rights and submit to LPA by POC date of 12/13/2025.

Allegation investigated: Staff neglect resulted in a resident to be hospitalized Staff did not provide adequate care and supervision

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA met with facility House Manager, Terry Lacey and explained the purpose of today's visit. Regarding the allegation Staff neglect resulted in a resident to be hospitalized. Facility staff was in the facility bathroom with Resident 1 assisting with activities of daily living when they fell. 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. Continued... Unsubstantiated Regarding the allegation Staff did not provide adequate care and supervision. The facility staff was present and supervising resident 1 when the fall occurred. The facility staff was providing care to Resident 1 when the fall took place. 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 facility House Manager Terry Lacey , and copy of report providedthe state’s words, verbatim · CDSS document, Dec 12, 2025 · control 24-AS-20250910190809

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 13, 2025

87464 Basic Services (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. The following requirement has not been met as evidenced by: Resident 1 was observed not properly positioned in their bed, which poses an immediate, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Licensee will conduct training on correct positioning and submit to LPA by POC date of 12/13/2025.

Allegation investigated: Staff do not provide adequate supervision resulting in residents falling and sustaining injuries. Staff did not seek medical attention for resident. Staff does not ensure residents are fed. Staff does not ensure resident's showering needs are being met. Staff does not ensure a food menu is available for residents.

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA met with facility House Manager, Terry Lacey and explained the purpose of today's visit. Regarding the allegation Staff do not provide adequate supervision resulting in residents falling and sustaining injuries. Resident 1 did have a bruising but it is not clear how the injury was sustained. 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. Unsubstantiated Regarding the allegation Staff did not seek medical attention for resident. Resident 2 did have what appeared to be a rash. The rash was treated within 48 hours.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. Regarding the allegation Staff does not ensure residents are fed. LPA has witnessed residents being fed on multiple visits to the facility including on 08/08/25, 09/10/25, and 09/12/2025. LPA observed food including meat, fruit and snacks inside the facility refrigerator and pantry. 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. Regarding the allegation Staff does not ensure resident's showering needs are being met. LPA interviewed one facility resident and 3 facility staff who all stated the residents are being showered and they do have a shower schedule. 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. Regarding the allegation Staff does not ensure a food menu is available for residents. LPA did observe a menu available for residents. The facility is very flexible with food provided as residents often request different food meals and food items. 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 facility House Manager Terry Lacey , and copy of report providedthe state’s words, verbatim · CDSS document, Dec 12, 2025 · control 24-AS-20250815103726

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80072(a)(3) · Plan of correction due date: Dec 13, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.The following requirement has not been met as evidenced by: Based on interviews conducted resident 1 slept on the floor despite no documentation in medical assesment., which poses a potential, helth, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2025

Plan of correction: Licensee will conduct training on personal rights and submit to LPA by POC date of 12/13/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management visit. LPA Hurt met with facility Facility staff Terry Lacey and Licensee Lidia Silveira. LPA observed Resident 1 was admitted to this facility on 12/24/2024, and resident 1's medical assessment was completed on 09/22/2020, signed by physician on 08/04/2021. LPA Hurt has visited the facility on 01/15/2025, 08/18/2025,09/10/2025, 09/12/2025,and 09/16/2025. LPA has never met or observed the facilities Administrator to be present at this facility despite there being multiple complaints since 08/2025. LPA interviewed multiple facility staff who all stated they have either never seen or rarely see the facilities Administrator. LPA Hurt observed Resident 2's appraisal has not been done since 08/2021. The following deficiencies are being cited Per Title 22 Regulations, and a copy of this report along with appeals rights provided.the state’s words, verbatim · CDSS document, Dec 8, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Dec 22, 2025

87458 Medical Assessment(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. The following requirement has not been met as evidenced by: Resident 1 was admitted to the facility 12/2024, and medical assessment is dated 09/2020, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 8, 2025

Plan of correction: Licensee will submit resident 1's current medical assesment to LPA by POC date of 12/22/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Dec 22, 2025

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. The following requirement has not been met as evidenced by: Based on interview with staff and LPA observation the facilities Administrator is not present at facility sufficient number of hours to manage the facility, which poses a potential, health, safety or personal rights risk to residents in care. vthe state’s words, verbatim · CDSS document, Dec 8, 2025

Plan of correction: Licensee will submit the LIC500 to LPA by POC date of 12/22/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Dec 22, 2025

87463 Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. The following requirement has not been met as evidenced by: Resident 2's appraisal has not been updated since 09/2020, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 8, 2025

Plan of correction: Administrator will submit current updated appraisal for resident 2 by POC date of 12/22/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management visit. LPA Hurt met with facility Facility staff, Laura Huerta, and House Manager Terry Lacey and explained the purpose of today's visit. LPA obtained records for R1 on 09/12/2025. LPA is returning records for R1 today. Exit interview conducted with Facility staff, Laura Huerta, and House Manager Terry Lacey by phone. and copy of report provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a Case Management visit. LPA Hurt met with facility Facility staff, Deon Webster, and House Manager Terry Lacey and explained the purpose of today's visit. LPA obtained records for R1 will make copies of records and return within 3 business days. Exit interview conducted with Facility staff, Deon Webster, and House Manager Terry Lacey by phone. and copy of report provided.the state’s words, verbatim · CDSS document, Sep 12, 2025

Allegation investigated: Staff are not properly discarding residents medication.

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to open a complaint investigation. LPA met with facility staff Yolanda Anguiano facility House Manager, Terry Lacey by phone and explained the purpose of today's visit. Regarding the allegation Staff are not properly discarding residents medication.The facility Administrator is not signing the medication destruction log as required. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Exit interview conducted and copy of report provided to facility staff Yolanda Anguiano, and House Manager Terry Lacy by phone. Substantiatedthe state’s words, verbatim · CDSS document, Sep 10, 2025 · control 24-AS-20250902151138

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i) · Plan of correction due date: Sep 24, 2025

87465 Incidental Medical and Dental Care(i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following:(1) Name of the resident.(2) The prescription number and the name of the pharmacy.(3) The drug name, strength and quantity destroyed.(4) The date of destruction. The following requirement has not been met as evidenced by: Based on records reviewed the facility is not correctly documenting medication destruction, which poses a potential, health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: Administrator will conduct medication destruction training with facility staff and submit proof to PLPA by POC date of 09/24/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with facility staff Facility staff, Terri Lacey Continual Administrator Certification for Licensee Lidia Silveira expired 10/04/2024. The Administrator Certification Bureau received application for renewal on 10/07/2024. There are currently 5 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 119 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. The facility does have an Emergency Disaster plan but it is on the older version of the form. Facility staff present did not provide Infection Control Plan, or Plan of Operation. Staff 1 does not have Health Screening Report. Resident 1 does not have required Tuberculosis Screening. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Facility staff, Terri Lacey, and copy of report left at facilitythe state’s words, verbatim · CDSS document, Jan 15, 2025

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility Caregiver Maria Beltran, Continual Administrator's Certification expires for Lidia Silveira 10/04/2024. There are currently 5 residents who reside at this home and there is 1 resident on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. Water temperature was tested at 106 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. The facility does have a current Emergency disaster plan, and conducts disaster drills as required. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Facility Caregiver Maria Beltran, and copy of report left at facilitythe state’s words, verbatim · CDSS document, Jan 30, 2024