Loving Heart Manor

Type of visit: Office

An Informal Office Meeting was conducted on this date at the Regional Office to discuss concerns that were observed during the Annual Inspection on 10/31/2025. Present during the meeting were: See Moua, Licensing Program Manager Sarah Hurt, Licensing Program Analyst Juanito Estamo. Licensee Maria Estamo, Assistant Administrator The following issues were discussed and deficiencies are cited on the attached 809-D page: - Criminal Record Clearance: 87355(e)(2) - Obtain a California clearance or a criminal record exemption as required by the Department…Staff 1 was not fingerprint cleared. Civil penalty was also assessed. - Incidental Medical and Dental Care: 87465(h)(6) - The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained…R5’s medications was not listed on the Centrally Stored Medication Records - Fire Clearance: 87202(a) - All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal…Resident 2 is bedridden and this facility does not have fire clearance for bedridden residents. - Storage Space and Access: 87309(a)-…the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage…Toxins and cleaning supplies accessible to residents in hallway bathroom. - Resident Records: 87506(a) - The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Resident 1 does not have annually updated Needs and Services plan. Resident 3 does not have a Needs and Services Plan, admission assessment, TB test or required consent forms. - Reporting Requirements: 87211(a)(1) - Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…Licensee did not notify Licensing of residents being admitted to hospice care. Resident 4 passed away on August 19,2025. The facility did not notify Licensing of the resident’s passing. The following concerns were also discussed: - Facility does not have required disaster drills - Hospice binders do not have required staff training - Staff 2 does not have required TB test - Facility Emergency Disaster Plan - Current/updated resident roster The licensee agrees to increased facility monitoring, and completing Licensing Technical Support Program. Exit interview conducted with Juanito Estamo, and Maria Estamo. Appeals rights were given.the state’s words, verbatim · CDSS document, Feb 2, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 3, 2026

- Criminal Record Clearance: 87355(e)(2) - Obtain a California clearance or a criminal record exemption as required by the Department…The following requirement has not been met as evidenced by: Staff 1 was not fingerprint cleared. which poses an immediate, heatlh, safety, or personal rights risk to residents in care. Civil penalty was also assessedthe state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: staff 1 is confirmed to be fingerprint cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(6) · Plan of correction due date: Feb 3, 2026

- Incidental Medical and Dental Care: 87465(h)(6) - The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained…The following requirement has not been met as evidenced by: R5’s medications was not listed on the Centrally Stored Medication Records, which poses an immediate, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee will submit staff training on the subject of documenting Centrally Stored medications and submit to LPC by POC date of 02/03/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Feb 3, 2026

- Fire Clearance: 87202(a) - All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal…The following requirememt has not been met as evidenced by: Resident 2 is bedridden and this facility does not have fire clearance for bedridden residents, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee will submit required documents to allow care of bedridden residents to LPA by POC date of 02/03/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87878 · Plan of correction due date: Feb 3, 2026

- Storage Space and Access: 87309(a)-…the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage…The following requirement has not been met as evidenced by: Toxins and cleaning supplies accessible to residents in hallway bathroom., which poses an immediate health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee will submit staff training on proper storage of chemicals to LPA by POC date of 02/03/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Feb 16, 2026

- Resident Records: 87506(a) - The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. The following requirement has not been met as evidenced by: Resident 1 does not have annually updated Needs and Services plan. Resident 3 does not have a Needs and Services Plan, admission assessment, TB test or required consent forms, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee will complete TSP training and will ensure resident and staff records are updated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Feb 16, 2026

- Reporting Requirements: 87211(a)(1) - Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…The following requirement has not been met as evidenced by: Licensee did not notify Licensing of residents being admitted to hospice care. Resident 4 passed away on August 19,2025. The facility did not notify Licensing of the resident’s passing, which poses a potential, health, safety, or personal rights risk to residents in care/the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee will complete TSP training and will ensure resident and staff records are updated

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 Licensee Juanito Estamo, Continual Administrator's Certification for Maria Christine Estamo expires on 02/17/2026. There are currently 4 residents who reside at this home and there is 3 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. Water temperature was tested at 116 degrees. First Aid kit is on site and complete. LPA observed the following deficiencies. Toxins and cleaning supplies accessible to residents in hallway bathroom. The facility has 3 residents currently under hospice care. Licensee did not notify Licensing of residents being admitted to hospice care. Resident 1 does not have annually updated Needs and Services plan. Facility does not have required disaster drills. Hospice binders do not have required staff training. Resident 2 is bedridden and this facility does not have fire clearance for bedridden residents. Resident 3 does not have a Needs and Services Plan, admission assessment, TB test or required consent forms. Staff 1 is not fingerprint cleared. Staff 2 does not have required TB test. Facility Emergency Disaster Plan does not have Fresno Regional Office contact information listed, and previous facility named is listed. Facility Emergency Disaster Plan was last reviewed/updated on 10/04/2021. Emergency Disaster Plan does not list Resident Assembly Points. Facility does not have current/updated resident roster. Resident 4 passed away on August 19,2025. The facility did not notify Licensing of resident passing. Resident 5's medication is not listed on Centrally Stored Medication record. Citations will be issued during Informal Office Meeting at Fresno Regional Office. 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 Licensee Juanito Estamo, and copy of report left at facility.the state’s words, verbatim · CDSS document, Oct 31, 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 Licensee, Juanito Estamo, Continual Administrator's Certification expires 03/05/2025. There are currently 5 residents who reside at this home and there is 1 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. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. First Aid kit is on site and complete. The facility could not provide Resident 1's hospice care plan. Resident 1 does not have required pre admission appraisal. LPA observed bleach under the sink in Resident 2's bedroom. LPA observed medications on the kitchen table accessible to residents. Resident 3's medication was not properly documented on the Centrally Stored Medication logs. Resident 3 does not have required annually updated medical assessment. Resident 3 did not have an updated Needs and Services plan. Staff 1 has no CPR first aid/ no 501 Employment application, no 503 Health Screening, no training on file. Fire extinguisher is not within the safety regulation period (5/2023.) LPA observed resident hallways bathroom water measures at 104 degrees. 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 Licensee, Juanita Estamo, and copy of report left at facilitythe state’s words, verbatim · CDSS document, Dec 5, 2024