Holy Angel Home Care 1

Type of visit: Required - 1 Year

On 12/16/2025 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Administrator, Alexandria Liu and explained the purpose of the visit. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 8/14/2025. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 112.4 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mats in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. LPA reviewed 3 residents and 4 staff files starting at 10:25AM. LPA reviewed a sample of resident's medications during inspection. At 11:30AM, LPA observed S4 has a positive TB skin test, but does not have a copy of the chest x-ray on file. At 11:45AM, LPA observed S4 does not have current First Aid training certificate on file. At 1:00PM, LPA was informed that facility does not have documentation for fire drills conducted. (Continue on LIC809C...) At 2:00PM, LPA observed R3 was missing medications including aspirin and acetaminophen. Facility does not have an updated list of R3's medications. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted with Alexandria Liu. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 16, 2025

The state marks this report as 12 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 12/15/2023 at 1:07PM, Licensing Program Analyst (LPA) T. Syess-Gibson, conducted an unannounced 1-Year Required inspection. LPA met with Merlita Vital, Caregiver and LPA explained the purpose of the visit. Merlita contacted Administrator via telephone and explained purpose of visit. Administrator, Alexandria Liu arrived at 1:32PM. The facility’s fire clearance was approved for five (5) non-ambulatory and 1 bedridden resident. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) total bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 111.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/14/2024. Emergency Disaster Plan was last posted on 12/13/2023. First aid kit was observed to be complete. Continued on LIC809C Continued from LIC809. Three (3) staff records were reviewed and all staff have criminal record clearance. All four (4) resident records were reviewed and complete. LPA requested the following documents to be submitted to CCLD by 12/11/2024. · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · Resident roster · Liability Insurance LPA observed the following deficiencies: · At 2:00PM, LPA observed bleach disinfectant spray, fabuloso multi-purpose cleaner, laundry detergent and Windex in an unlocked garage. · At 2:14PM, LPA observed scissors in an unlocked kitchen drawer. · At 3:13PM, LPA observed during file review S1 and S2 weren't available at the facility for inspection. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties Exit interview conducted and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 4, 2024

Type of visit: Required - 1 Year

On 12/15/2023 at 9:35am, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson, conducted an unannounced 1-Year Required inspection. LPAs met with Alexandria Liu, Administrator and LPA explained the purpose of the visit. The facility’s fire clearance was approved for five (5) non-ambulatory and 1 bedridden resident. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) total bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 122.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 8/14/2023. Emergency Disaster Plan was last posted on 10/4/2022. First aid kit was observed to be complete. Continued on LIC809. Continued from LIC809. Four (4) staff records were reviewed, and all staff have criminal record clearance. All three (3) resident records were reviewed and complete. LPA requested the following documents to be submitted to CCLD by 12/22/2023. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report Resident roster Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 15, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.