Hearted Care Assisted Living Facility

Type of visit: Required - 1 Year

On 06/04/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with care staff Lucia Rameriz and explained the purpose of the visit. Care staff then called and notified the Administrator Betelihem Aylem that CCLD was present in the facility. A brief interview was done with the Administrator Aylem via telephone. The Administrator Certificate # is 6070008740 and will expire on 08/31/2026. The current census is 1 with 1 facility staff. Approximately 3 hours later the Administrator Aylem arrived and joined the visit This facility is a single story building licensed to serve two (2) ambulatory and three (3) non-ambulatory residents and is also granted for hospice care for two residents. LPA Lee and care staff Rameriz inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 103.3 degrees Fahrenheit in resident bathroom sink, which is not within the required regulation of 105 to 120 degrees Fahrenheit. The smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in dining room and was purchased on 03/30/2026. It was observed and learned that the facility did not have an operable telephone on the premises. According to care staff Lucia, she was informed by the Administrator that AT&T was scheduled to visit the facility today to install telephone service. CONTINUED LIC 809-C The following documents will be emailed to LPA Lee at pang.lee@dss.ca.gov by end of day 06/11/2026 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with Administrator Aylem and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility. Failure to correct deficiencies may result in civil penalties. It was observed that the following information and poster was not posted in the facility "Rights of Resident Councils.” “Personal Rights of Residents in All Facilities” and PUB 475 complaint poster. Facility thermostat was observed at 68 degrees Fahrenheit, which is within the required regulation of 68 to 85 degrees Fahrenheit. LPA Lee observed toxins located in laundry cabinet and kept locked and inaccessible to resident LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to resident LPA Lee checked medication storage and found medication to be locked away and inaccessible to resident. The first aid kit was checked, and it did not contain the required components. Based on observation it was observed that the facility’s first aid kit does not have a first aid manual and a Thermometers during today’s visit LPA Lee audited medications for 1 out of 1 resident medications by reviewing the medication on hand with their Medication Administration Records (MAR) and based on review of the resident's medication records the medication Gabapentin 300 mg, prescribed as one capsule by mouth at bedtime, for 06/03/2036 was initialed on the MAR as having been administered to the resident. However, a review of the resident's Centrally Stored Medication and Destruction Record (CSMDR) revealed that the medication start date was not documented on the CSMDR. LPA Lee reviewed 1 out of 1 resident file, and they were complete. LPA Lee reviewed 2 staff files, and it was incomplete. Based on record review of 2 staff files, 1 out of 2 of the files did not have CPR/First Aid training. During today's visit, staff 1 (S1) on duty did not have CPR/First aid training in their file. S2 did not have their health screening and TB in their file and was later provided to LPA Lee at the end of the visit. S1 and S1 neither file contained documentation of required staff orientation or training records. S1 date of hire (DOH) is 06/02/2026 and S2 (DOH) is 06/02/2026. Furthermore, during today's visit, Administrator Aylem did not have her personnel file available at the facility for LPA Lee's review. According to Administrator Aylem, she had taken the file home to work on it. LPA reviewed staff criminal record clearances and a review of staff records revealed that S1 and S2 were not associated with the facility. S1, who was working during today's visit, was found to be fingerprint cleared; however, they have not yet been associated with the facility. LPA Lee advised the Administrator Aylem that all employed, and volunteer individuals must be associated prior to providing care and supervision at the facility. CONTINUED LIC 809-Cthe state’s words, verbatim · CDSS document, Jun 4, 2026

The state marks this report as 14 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 07/10/2025 at 8:50 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with administrator Wendy and explained the purpose of the visit. The current census is 1 with 2 facility staff. This facility is a single story building licensed to serve (3) non-ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 105.9 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in the kitchen area and was last serviced on 06/03/2025. LPA observed the facility has a public telephone in the common area and the facility has the required posters posted. Facility thermostat was observed at 75 degrees Fahrenheit. LPA observed toxins located in the laundry room kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. LPA checked medication storage and found medication to be locked away and inaccessible to residents. Continuation 809-C LPA reviewed 1 out of 1 resident medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA reviewed 1 out of 1 resident files and they were complete. LPA reviewed 2 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 07/10/2025 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulations, An exit interview was conducted with Wendy and a copy of these LIC 809 reports, were provided to the facility.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Prelicensing

On 6/21/24, Licensing Program Analyst (LPA) Tung Truong arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA met with Applicant, Daniel Abetew who assisted LPA in today’s inspection. Administrator holds current certification #6067711740 and expires on 9/25/25. It was learned that this facility will be licensed to serve up to five (5) ambulatory residents only. There are no residents in care currently. LPA toured the facility with Daniel Abetew. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed the facility is clean and furnished. LPA observed rooms to have required furniture. Although there were no residents, LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 70*F which is within the required range of 68-85*F. Hot water temperature was measured at 105.1*F and is within the required range of 105-120*F. LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguishers and first aid kit were up to date. LPA observed the centrally stored medication areas to be locked and made inaccessible to the residents at this time. LPA observed no obstruction of emergency exits inside or outside of facility. Based on a review of this facility during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time. Component III conducted with the applicant. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. Per the California Code of Regulations Title 22, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was given to the applicant.the state’s words, verbatim · CDSS document, Jun 21, 2024