Jhehan Faith

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Beena Singh met with a staff, was granted entry to the facility. At the time of the visit there were one(1) staff present, and four (4) residents present. Licensee/Administrator Heldo Taguba was contacted and arrived during the visit. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room and detached garage/stock room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and one (1) may be bedridden resident. The facility has six (6) Hospice Waiver and has two(2) hospice residents at the facility. The current census is four(4) residents. LPA Singh was accompanied by Licensee/Administrator Taguba (S1) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA Singh observed no obstructions to outdoor passageways. The facility is maintained at a comfortable temperature LPA Singh inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Singh observed grab bars and customized tiles that functions as non-skid mat or strips in the resident bathrooms. Moreover, during the tour of the facility, LPA Singh observed the knives and sharps drawer was locked in the kitchen and not accessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the kitchen. Also, LPA Singh observed a complete first aid kit maintained and readily available at the facility. LPA Singh measured and observed the water temperatures in the bathroom to be at 118 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster and the disaster plan, Infection Control Plan were posted in a common area. Food Service: Seven (7) days of non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Singh observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Singh reviewed two (2) resident files for admission agreements, updated physician reports, and needs and services plans. The files were complete with updated physician’s reports, admissions agreements, and pre-admissions appraisals. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications/MAR records were audited and appeared to be dispensed appropriately by staff members. Liability Insurance valid through 12/12/2025-12/12/2026. Fire drill conducted on 07/29/2026 and Earthquake drill was conducted on 07/31/2026. An exit interview was conducted where this report was discussed and provided to Licensee/Administrator Heldo Taguba.the state’s words, verbatim · CDSS document, Sep 15, 2026

Allegation investigated: Staff did not ensure medication/sharps/chemicals were locked and inaccessible. Administrator certificate is expired.

On 03/25/2026, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility for the purpose of initiating an investigation into the above complaint allegation. LPA met with Facility Staff-Marisol Cortes and explained the reason for the visit. Census is four(4) residents. Facility Licensee/Administrator Heldo Taguba and Hanna Taguba was informed of the visit and arrived during the visit. During today’s visit, LPA Singh requested documents, received copies of the documents and interviewed staff and residents. First Allegation:- Staff did not ensure medication/sharps/chemicals were locked and inaccessible LPA Singh observed medication/sharps/chemicals were locked and inaccessible to any residents in care. Two(2) out of four (4) residents in care are non-ambulatory and Two(2) are ambulatory. Two(2) out Four(4) residents stated they never come to the kitchen and staff is always there to assist them. Three(3) out of Three(3) staff stated that knives and sharps are always locked and inaccessible to the residents in care. Unfounded Second Allegation:- Administrator certificate is expired. Licensee provided LPA Singh, Administrator certificate for Jennifer Taguba is current and effective date 12/01/2025 Expiration date- 11/30/2027. Licensing Program Analyst(LPA) Singh checked the certificate and confirmed Administrator certificates for the Licensee/Administrator-Heldo Taguba and two other Administrators are current and not expired. Based on the evidence gathered, the allegation is deemed UNFOUNDED. A finding that the complaint allegation is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the allegation dismissed. An exit interview was conducted where this report LIC9099 was discussed and provided to Licensee/Administrator- Heldo Taguba. An exit interview was conducted where this report was discussed, and a copy was provided to Facility Licensee/Administrator Heldo Taguba.the state’s words, verbatim · CDSS document, Mar 25, 2026 · control 56-AS-20260325082231

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Beena Singh met with a staff, was granted entry to the facility. At the time of the visit there were two (2) staff present, and four (4) residents present. Licensee/Administrator Heldo Taguba was contacted and arrived during the visit. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room and detached garage/stock room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and one (1) may be bedridden resident. The facility has six (6) Hospice Waiver. The current census is four(4) residents. LPA Beena Singh was accompanied by Licensee/Administrator Taguba (S1) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA Beena Singh observed no obstructions to outdoor passageways. The facility is maintained at a comfortable temperature LPA Beena Singh inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Beena Singh observed grab bars and customized tiles that functions as non-skid mat or strips in the resident bathrooms. Moreover, during the tour of the facility, LPA Beena Singh observed the knives drawer was locked in the kitchen and not accessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the kitchen. Also, LPA Beena Singh observed a complete first aid kit maintained and readily available at the facility. LPA Beena Singh measured and observed the water temperatures in the bathroom to be at 110 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster and the disaster plan, Infection Control Plan were posted in a common area. Food Service: Seven (7) days of non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Beena Singh observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Beena Singh reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. The files were complete with updated physician’s reports, admissions agreements, and pre-admissions appraisals. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications/MAR records were audited and appeared to be dispensed appropriately by staff members. Liability Insurance valid through 12/12/2024-12/12/2025. Fire/disaster/Earthquake drill was conducted on 10/03/2025. An exit interview was conducted where this report was discussed and provided to Licensee/Administrator Heldo Taguba.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Beena Singh met with a staff, was granted entry to the facility. At the time of the visit there were three (3) staff present, and three (3) residents present. Licensee/Administrator Heldo Taguba was contacted and arrived during the visit. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room and detached garage/stock room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and one (1) may be bedridden resident. The facility has six (6) Hospice Waiver. The current census is three (3) residents. LPA Beena Singh was accompanied by Licensee/Administrator Taguba (S1) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA Beena Singh observed no obstructions to outdoor passageways. The facility is maintained at a comfortable temperature. LPA Beena Singh inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Beena Singh observed grab bars and customized tiles that functions as non-skid mat or strips in the resident bathrooms. Moreover, during the tour of the facility, LPA Beena Singh observed the knives drawer was locked in the kitchen and not accessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the kitchen. Also, LPA Beena Singh observed a complete first aid kit maintained and readily available at the facility. LPA Beena Singh measured and observed the water temperatures in the bathroom to be at 109 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster and the disaster plan, Infection Control Plan were posted in a common area. Food Service: Seven (7) days of non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Beena Singh observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA Beena Singh reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. The files were complete with updated physician’s reports, admissions agreements, and pre-admissions appraisals. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications/MARs records were audited and appeared to be dispensed appropriately by staff members. An exit interview was conducted where this report was discussed and provided to Licensee/Administrator Heldo Taguba.the state’s words, verbatim · CDSS document, Nov 7, 2024

Type of visit: Required - 1 Year

On 12/18/2023 at 09:00 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with a staff, was granted entry to the facility. At the time of the visit there were three (3) staff present, and three (3) residents present. Licensee/Administrator Heldo Taguba was contacted and arrived during the visit. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room and detached garage/stock room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and one (1) may be bedridden resident. The facility has six (6) Hospice Waiver. The current census is three (3) residents. LPA Brown was accompanied by Licensee/Administrator Taguba (S1) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). LPA Brown observed no obstructions to outdoor passageways. The facility is maintained at a comfortable temperature. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and customized tiles that functions as non-skid mat or strips in the resident bathrooms. Moreover, during the tour of the facility, LPA Brown observed the knives drawer not locked in the kitchen and accessible to residents in care. Deficiency will be issued as this pose immediate safety risks to residents in care. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the kitchen. Also, LPA Brown observed a complete first aid kit maintained and readily available at the facility however, no current edition of First Aid ***Continuation in LIC809C *** Manual approved by the American Red Cross, the American Medical Association or a state or federal health agency observed at the facility. Deficiency will be issued. To add to that, LPA Brown measured and observed the water temperatures in the bathroom to be at 115 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster and the disaster plan, Infection Control Plan were posted in a common area. Food Service: Seven (7) days of non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. LPA Brown observed sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. The files were complete with updated physician’s reports, admissions agreements, and preadmissions appraisals. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA found that Staff #2 (S2) does not have Health Screening Report in S2’s facility file. Deficiency will be issued. Furthermore, LPA Brown observed Staff #3 (S3) working at the facility without criminal background clearance. Deficiency and civil penalty of $500.00 will be issued during the facility visit today and will continue to be assessed of $100.00 per day until corrected. Medications/MARs records were audited and appeared to be dispensed appropriately by staff members. An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Heldo Taguba.the state’s words, verbatim · CDSS document, Dec 18, 2023