Magdalene Residential Care II

Type of visit: Required - 1 Year

On 11/14/2025, Licensing program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection. LPA met with Administrator Fe Hilario and explained the purpose of today’s visit. All residents are present in the facility and 3 staff are present at time of the inspection. This is a single level facility with three bedrooms for clients in care. The facility is licensed for age range 60 and over. 6 non-ambulatory, which 1 may be bedridden. Non-ambulatory in rooms 1-4. Bedridden in room 5. Hospice waiver for 3. Currently there is no residents on hospice. LPA Vado toured the facility both inside and outside. All outdoor and indoor passageway are free and clear of obstructions for emergency exit routes in case of fire or emergency. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and 2 days of perishable foods as in place. Knives are locked in the kitchen in a drawer beneath the cooking range. Toxic chemicals are stored in a locked cabinet located in the garage. Centrally stored medications are locked in a cabinet inside a designated office within the facility and in the kitchen in a cabinet adjacent to the refrigerator. LPA observed all resident rooms as clean, free of odors, and contained all the required furniture per regulatory recommendations. Facility has functioning smoke detectors and carbon monoxide detectors within the facility. Continued on next page... Page 2 The facility is equipped with two full bathrooms for resident use, which are in good working order. Shower floors are equipped with non-skid mats. Water temperature is tested at 117F in one of the resident bathrooms. Fire extinguishers are observed in the facility. Both observed as charged and ready for use per the dial reading on the extinguishers with an inspection tag of 04/29/2025. Last fire and earthquake drill were both conducted on 05/17/2025. LPA reviewed 5 resident files and 5 staff files, which are all current. Facility administrator certificate is observed as current. No citations are issued during today's visit. Report is reviewed with the administrator and a copy of this report is provided.the state’s words, verbatim · CDSS document, Nov 19, 2025

Type of visit: Required - 1 Year

On January 22, 2025, at 08:50 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the caregiver, Elsa Lopez, and disclosed the purpose of the inspection. The caregiver informed the LPA that the facility had (6) residents in care and (3) staff members present at the time. LPA observed (2) staff members in the kitchen preparing breakfast and (1) staff member assisting residents with the breakfast on the dining table. At 9:24 AM, the LPA initiated a walk-through of the facility, accompanied by the caregiver. LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. The LPA observed (5) residents eating breakfast at the dining table. LPA inspected the living room and observed it clean, with all furniture in good repair. There were reclining chairs and a television in the living room. LPA inspected the fire extinguisher mounted on the wall in the living room and found it fully charged, with the last service tag dated 04/09/2024. The caregiver tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. There were (6) bedrooms and (2½) bathrooms designated for residents' use. All resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. LPA observed scissors on a table in room #1 and another scissors on top of chest in room #3, accessible to residents. LPA inspected (2) full bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip mats. The hot water temperature at the sink faucet measured 108.5°F in bathroom #1 and 109.2°F in bathroom #2. Continued on 809-C LPA inspected the kitchen and found it clean, with breakfast preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects, and a locked cabinet under the sink with detergents and cleaning supplies. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the storage closet in the hallway and observed it contained clean linens, blankets, and towels for residents’ use. LPA inspected the garage and found it clean. A washer, a dryer, a freezer containing additional food supplies, and a closet containing detergents and paper products were observed. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. No bodies of water were noted. The LPA inspected (2) storage sheds and observed wheelchairs, furniture items, bedframes, mattresses, outdoor furniture, outdoor heaters, and PPE products stored in the sheds. Auditory alarms was observed to be working on all the exit doors. LPA reviewed (6) staff personnel records and (5) resident records. The LPA observed that 5 of 5 residents had an Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. 1 of 5 residents (R4) was missing a completed safeguards for property/valuables form. 1 of 5 residents (R2) was missing personal rights forms. LPA observed that 5 of 5 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 5 of 5 staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet inside the kitchen. Medications were organized in separate bins for each resident. 6 of 6 resident medication prescription labels were altered with the handwritten notes using a black marker pen. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 11/20/2024. Continued on 809-C The following updated forms are requested to be submitted to CCLD by 01/29/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility LIC 999: Facility Sketch (Floor Plan) Certificate of Liability Insurance Current Property Lease Agreement Administrator Certificate(s) A deficiency is being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the caregiver. A copy of this report and appeal rights were discussed and left with the caregiver, Elsa Lopez, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 22, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 1/26/24, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required inspection. LPA introduced self, stated purpose of visit, and allowed entrance by care staff. LPA met with Licensee, Fe Literator-Hilario. Fe also serves as facility Administrator Certificate #6029517740. Currently, six (6) residents in care. All residents were present during inspection. Residents observed relaxing in the living room, watching television. Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. LPA observed leftovers stored in the refrigerator and/or freezer observed to be properly stored and labeled. Medications observed to be locked in small cabinet in kitchen. Smoke Alarms and carbon monoxide detectors observed to be operational during time of inspection. Fire extinguisher has a service date of 4/03/2023. Last fire drill conducted on 12/15/2023 according to facility records. All cleaning supplies observed to be locked and secured under kitchen sink. Outside areas toured. All exits open freely and observed to be free of obstruction. LPA observed side gate that exits to front of facility is not self latching. No hazards observed. The following documents were submitted to San Bruno Regional Office in September 2023: LIC 308, LIC 400, LIC 500, LIC 503, LIC 610E, Administrator Certificate, Liability Insurance. Exit interview conducted with Administrator. Deficiency cited on the attached 809-D. A copy of this report provided to Administrator for facility records.the state’s words, verbatim · CDSS document, Jan 26, 2024