Hazelwood Mighty Homes

Type of visit: Required - 1 Year

At 9:15a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Administrator and explained the reason for the visit. At approximately 9:55a.m., Licensee/Administrator joined today’s visit. At 10:00a.m., Administrator and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a single -story home in a residential community. The front main door is the only entrance being utilized at the facility, it has four (04) bedrooms and two (02) bathrooms. One (01) private bedroom and two (02) shared empty rooms designated for residents, and one (01) bedroom for live in staff. Fire/Earthquake drill was last conducted on 02/10/2026. Required posting observed displayed in the facility living room (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 70 degrees Fahrenheit. The fire alarm system was tested and observed to be working, it is hard wired and interconnected. The carbon monoxide detector is located on the wall in the kitchen. No obstructions and/or tripping hazards throughout the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. Furniture in common areas was observed to be in good repair. Residents dining table fits six (06) residents. Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, bedding, (Cont. to LIC 809-C) (Cont. from LIC 809) and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Staff bedroom is designated only for living in Administrator. Every bedroom, hallway area and kitchen has smoke detectors that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range within the required range. Residents’ personal hygiene supplied are kept in their personal space. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in a cabinet near the exit door to the back of the kitchen. Toxins, cleaning solutions, and soap stored and locked underneath the kitchen cabinet sink. Fire extinguishers were observed to be located in the kitchen area. Fire extinguishers were observed to be fully charged and operable. Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrapped and stored properly as well. Food storage and preparation areas are clean. Medication was observed to be locked in a chest drawer. Store in the dining area inaccessible to residents in care. In the hallway, there is a locked closet with a complete first aid kit, manual and staff folders. Garage is detached from the house and observed to be locked and inaccessible to residents. The garage storages extra supplies, laundry detergents and cleaning agents. Laundry Room: LPA observed washer and dryer machines located outside on the back of the facility. LPA observed to be clean and clear from obstruction. Laundry soap, toxins and cleaning supplies are stored outside on a shelf near the laundry machines, inaccessible to residents. Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. A covered canopy area with tables and chairs for lounging, the front porch area is shaded with chairs for lounging. The outdoor area was enclosed, and no bodies of water were observed on the premises. Resident Record. One (01) resident record was reviewed. Resident records were complete and current at this time. Staff Records were also reviewed they all have criminal record clearances and are associated with this facility. Staff have current cardiopulmonary resuscitation (CPR) and first aid training. Administrator's certificate was observed to be current. No deficiencies cited during the visit. Exit interview conducted. A copy of the report was provided to Licensee/Administrator.the state’s words, verbatim · CDSS document, Mar 10, 2026

Type of visit: Required - 1 Year

At 9:30a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Administrator and explained the reason for the visit. At approximately 9:55a.m., Licensee/Administrator joined today’s visit. At 10:00a.m., Administrator and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a single -story home in a residential community. The front main door is the only entrance being utilized at the facility, it has four (04) bedrooms and two (02) bathrooms. One (01) private bedroom and two (02) empty rooms designated for residents, and one (01) bedroom for live in staff. Fire/Earthquake drill was last conducted on 02/20/2025. Required posting observed displayed in the facility living room (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 72 degrees Fahrenheit. The fire alarm system was tested and observed to be working, it is hard wired and interconnected. The carbon monoxide detector is located on the wall in the kitchen. No obstructions and or tripping hazards throughout the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. Furniture in common area was observed to be in good repair. Residents dining table fits six (06) residents. Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Staff bedroom is designated only for live in Administrator. (continued to LIC 809-C) (continued from LIC 809) Every bedroom, hallway area and kitchen has smoke detectors that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 110.7°F to 118.0°F and within the required range. Resident’s personal hygiene supplied are kept in their personal space. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in a cabinet near the exit door to the back of the kitchen. Toxins, cleaning solutions, and soap stored and locked underneath the kitchen cabinet sink. Fire extinguishers were observed to be located in the kitchen area. Fire extinguishers were observed to be operable with service date of 02/07/2025. Food: LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap and stored properly as well. Food storage and preparation areas are clean. Medication was observed to be locked in a chest drawer. Stored in the dining area inaccessible to residents in care. In the hallway, there is a locked closet with a complete first aid kit, manual and staff folders. Garage is detached from the house and observed to be locked and inaccessible to residents. The garage storages extra supplies, laundry detergents and cleaning agents. Laundry Room: LPA observed washer and dryer machines located outside on the back of the facility. LPA observed to be clean and clear from obstruction. Laundry soap, toxins and cleaning supplies are stored outside on a shelf near the laundry machines, inaccessible to residents. Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. A covered canopy area with tables and chairs for lounging, the front porch area is shaded with chairs for lounging. The outdoor area was enclosed, and no bodies of water were observed on the premises. Resident Record. One (01) resident record were reviewed. Resident record is complete and current at this time. Staff Records were also reviewed they all have criminal record clearances and associated to this facility. Staff on duty do not have current cardiopulmonary resuscitation (CPR) and first aid training. Administrator's certificate was observed to be current. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit. Exit Interview Conducted / A Copy of the Report was provided to Licensee/Administrator.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Required - 1 Year

At 11:10 AM Licensing Program Analysts (LPAs), Huma Rahimi, and Perchui Milena Khurshudyan conducted an unannounced annual inspection at the facility mentioned above. LPAs met with Staff Lucena Dagoy, and at 11:45 AM the Administrator Elizabeth A Dagoy arrived at the facility and LPAs explained the reason for the visit. At 12:10 PM, Physical tour was conducted with the Administrator and LPAs observed the following: Censes: The current censes is 0. Kitchen: At approximately, 12:13 PM LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. LPAs observed sharps to be locked and stored in a cabinet near the exit door to the back of the kitchen. LPAs observed toxins, cleaning solutions, and soap stored and locked underneath the kitchen cabinet sink. Medications: The facility do not have any residents; therefore, no medications were observed. In the living room, the facility is having a chest drawer in which they keep the medications locked. Bedrooms: The facility has four (4) bedrooms. One of the bedrooms is designated for live-in staff. LPAs observed the staff room to be free of hazard and locked. LPAs observed all bedrooms to be clean and clear from obstruction, properly furnished, sufficient lighting, appropriate bedding and linens. Trash cans observed to have attached lid. Bathrooms: At 12:20 PM, LPAs observed the bathrooms to be clean and in good repair. LPAs observed the appropriate grab bars in and around the toilet and shower also non-skid mats are located in the shower area. The water temperature measured 119.2 degrees Fahrenheit. Hand towels and wash clothes are not shared Continue on LIC809-C Common Areas: The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away. Smoke detectors/carbon monoxide. At 12:28 PM, the fire alarm system was tested and observed to be working, it is hard wired and interconnected. The carbon monoxide detector is located on the wall in the kitchen. Outside areas: At 12:35 PM, LPAs observed the backyard and surrounding area of the facility to be clean and clear from debris. A covered canopy area with tables and chairs for lounging, the front porch area is shaded with chairs for lounging. A detached garage observed to be locked and currently used as storage. No bodies of water observed on the premises. Laundry Room: LPAs observed the washing machines located outside in the back of the facility. LPAs observed to be clean and clear from obstruction. Laundry soap, toxins and cleaning supplies are stored outside on a shelf near the laundry machines, inaccessible to residents. Between 1:00 PM to 1:30 PM, LPAs reviewed records of one (1) resident (R1) and two (2) staff. LPAs reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Community Care Licensing Department (CCLD) in a timely manner. Based on Title 22 Regulation: a written Unusual Incident / Injury Report / Death shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters, and they are all responsible for reporting. Additionally, upon request of the Certificate of Liability Insurance, the Administrator stated that they cancelled the insurance due to the financial hardship on or about July, 2023. Continue on LIC 809C LPA informed the Administrator to submit the following one (1) Death Report that occurred on: · 01/14/24 · Certificate of Liability Insurance Per the California Code of Regulations, Title 22, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Feb 9, 2024