Loving Hearts Care Home II

Type of visit: Required - 1 Year

At approximately 9:30 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by caregiver. Administrator Dinah Belandres was called and arrived at approximately 10:10 AM. Licensee Rose Devera arrived shortly after. Facility is a Residential Care Facility for the Elderly (RCFE) with five (5) residents in care. Facility has Hospice waiver for three (3), with zero (0) Hospice residents currently in care and is approved for all non-ambulatory residents. At approximately 10:15 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 6/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 107.2 and 118.5 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed three (3) locked sheds in the backyard which were shown to contain staff belongings and additional equipment. Continued LIC809C... Continued from LIC809... Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. Facility conducts quarterly disaster drills, and the most recent drill was conducted 7/25. LPA observed facility's emergency disaster plan which was last updated 7/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 10:45 AM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 11:30 AM LPA conducted review of three (3) staff records. All required documentation present. At approximately 11:45 AM LPA and Licensee conducted check of P&I. All records present and cash is reconciled. At approximately 12:00 PM LPA and Administrator/Licensee conducted a spot check of medication and medication records. Medication is centrally stored and locked. Dinah Belandres Administrator Certificate 7032809740 expires 2/17/2027. All fees are current as of this time. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources LIC402 - Surety Bond LIC610E - Emergency Disaster Plan No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, Sep 8, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 11/13/2024, Licensing Program Analyst (LPA) A. Canela conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and was greeted by care staff, Francisca Martinez. Administrator, Dina Belandres and licensee, Rose Devera arrived a few minutes later. The facility is licensed for six non-ambulatory residents and a hospice waiver for three. The facility currently provides care for six residents, of which one is receiving hospice services. LPA toured the facility with care staff and facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 6/11/2024. Both smoke detectors and carbon monoxide detectors throughout the facility were interconnected, tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Water at faucets accessible to residents was measured between 105 and 120 degrees which is within regulation. Toxins, sharps and other items that could pose threat if readily available to residents were kept locked under the kitchen and bathroom sinks and within cabinets in the laundry room all of which were found to be secured. During inspection, LPA observed three storage sheds located in the side yard to also be locked and secured. LPA reviewed two resident files and requested additional information regarding the shared room situation and verification that resident R1 and R2s personal rights are not being violated. LPA will return and complete inspection due to time restraint No citations issued at this time.the state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Required - 1 Year

On 11/7/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and was greeted by Administrator, Rose Devera. The facility is licensed for six non-ambulatory residents and a hospice waiver for three. The facility currently provides care for five residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility exits were equipped with auditory alarms for residents with dementia tested and found to be in working order. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 6/12/2023. Both smoke detectors and carbon monoxide detectors throughout the facility were interconnected, tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Water at faucets accessible to residents was measured between 109.9 and 110.3 degrees which is within regulation. Toxins, sharps and other items that could pose threat if readily available to residents were kept locked under the kitchen and bathroom sinks and within cabinets in the laundry room all of which were found to be secured. During inspection, LPA observed three storage sheds located in the side yard to also be locked and secured. Residents were observed engaging in discussion with staff, watching television shows or resting in their bedrooms. Residents appear to have a positive relationship with staff based on LPA observations. LPA found that the facility is utilizing pest traps in the garage. LPA confirmed with the Administrator and Pest Control company that the services are currently being implemented. Administrator contacted the Pest Control company confirming the services for precautionary measures. The facility conducts emergency disaster drills quarterly with updated logs on record and has a current emergency disaster plan. Continued onto LIC809-C There was a supply of hygiene products, continence products, paper products and clean linens available for residents. All resident bedrooms have lighting & appropriate furnishings. Medications are stored in a designated medication cabinet located in the dinning area were found to be secured. LPA conducted spot medication count and although LPA found Medication Administration Records in order, it was also found that three prescription medications were not properly recorded on the Centrally Stored Medication Record. Administrator will be conducting medication review to properly reconcile prescription information. LPA also conducted a file review for all residents and found residents to have updated Physician's Reports and Needs & Service Plans. Individual Program Plans for residents under North Bay Regional Center were also found to be current. During a review of staff files, LPA found all staff to have current 1st aid & CPR certification along with adequate annual training on file. Upon review of staff association on Caregiver Background Check roster LPA found that staff S1 was not properly associated to Loving Hearts Care Home II. LPA confirmed with the Regional Office and Guardian search that S1 is currently associated and cleared for two other residential care facilities. Administrator has previously submitted a transfer request for S1 but was not completed. Administrator re-submitted S1's transfer request to the Regional Office during the visit. LPA will follow through confirming the proper association. Technical Violation issued. Administrator, Rose Devera's Administrator Certificate 6008400740 is currently active through of 11/1/2024. LPA requested the following documents be sent to CCL by COB 12/7/2023: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Nov 7, 2023