Mama Angelina Coconocho

Allegation investigated: Staff are not meeting resident's medical needs. Staff did not contact home health with resident's blood pressure results.

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the investigation of the allegations listed above. LPA arrived unannounced and met with Staff, Crispin Dizon. The purpose of the visit was explained. The investigation consisted of the following: On 3/15/2024, LPA Yolanda Delgado conducted the initial visit and interviewed staff and a resident. LPA obtained copies of pertinent documentation. LPA Chan interviewed three (3) Staff via telephone on 6/12/26. During the visit today, LPA interviewed one (1) staff, four (4) residents, and a family member. The investigation revealed the following: Allegation - Staff are not meeting resident's medical needs. It was alleged that the facility staff was instructed by the home health nurse to check Resident #1’s (R1) blood pressure again in half an hour and give another dose of medication. This incident occurred back in March of 2024. Unsubstantiated LPA interviewed the administrator and Staff regarding this allegation. The administrator recalled that the home health nurse took the vitals for R1 and noticed the higher blood pressure reading. The nurse informed them to call 911. When the paramedics arrived, R1 refused to go to the hospital. Staff indicated that they were never given any instructions by the home health nurse. Staff continued to monitor R1’s blood pressure throughout the night until the next day. Staff stated that they are always monitoring the residents and will follow any instructions given by the nurses. Staff will communicate with the residents’ responsible party when they need medical attention or notice any changes in the residents. LPA spoke with a family member who stated that they did not request for R1 to receive home health services and stated that she takes R1 to the medical appointments. LPA interviewed four (4) residents. All four residents stated that their families take them to their medical appointments. Staff also communicate with their families when they notice any changes in the residents. Allegation - Staff did not contact home health with resident's blood pressure results. It is alleged that the staff did not contact the home health nurse regarding Resident #1’s blood pressure reading results. LPA Chan interviewed staff regarding this allegation. Staff indicated that the home health nurse did not provide any instructions to contact the nurse about R1’s blood pressure readings. The home health nurse also did not provide any paperwork regarding the services for R1. Staff stated that when R1’s blood pressure was high, staff was monitoring R1 throughout the night. The next day, R1’s blood pressure became stable. Staff interviewed stated that they communicate with the home health or hospice nurses if they notice any changes in the resident. Based on information gathered, there is insufficient evidence to corroborate this allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jun 13, 2026 · control 18-AS-20240308100814

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with Administrator, Maria Gonzalez. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of four (4) resident bedrooms, 0ne (1) staff bedroom, two (2) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, and a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 106.8 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan and Infection Control Plan is maintained. There are no firearms at this home and no bodies of water observed. LPA began review of client records. Four (4) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. Continued on LIC 809-C. LPA began review of employee records- four (4) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 09/26/2026. LPA observed one out four staff missing the Health Screening/TB and will need to be completed. A deficiency will be cited. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for chemicals and sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the kitchen allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers were serviced on 05/06/2025. Fire drills are conducted quarterly at the facility with the last drill on 09/20/2025 . Based on the information received during this visit today in the areas reviewed, there is one deficiency that is being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809, LIC 809-D and Appeal Rights reports were reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Sep 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon and Andrei Castillo conducted an unannounced annual required visit. Upon entry, LPA met with Maria Gonzalez, administrator, and informed them of the purpose of the visit. At the time of the visit, there were two (2) staff members and five (5) residents present. Facility Overview: The facility is a one-story home with four (4) bedrooms and two (2) bathrooms, including an attached garage. There are no pools or firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 117.5°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for three (3) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 8-28-2024, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility for a complaint visit. The LPA met with Administrator, Maria Gonzalez, and informed her of the purpose for the visit. During the visit the LPA toured and inspected the property. The LPA observed a lock on the exterior gate. No secondary exit was available. In addition, a bedridden resident was observed to be in care. Resident Three's (R3's) Physician's Report for Residential Care Facilities for the Elderly (RCFE) noted the resident was non-ambulatory and bedridden. The resident agreed to attempt to reposition themself in bed, though was unable to physically do so. The facility does not have an approved fire clearance for a bedridden resident. During an inspection of the facility's food supply the LPA observed medications in the facility's refrigerator. The medications were not maintained secured from any unauthorized individuals, rather was stored on the right-side door of the kitchen refrigerator. The backyard fence had missing and/or broken wooden panels and the care staff were observed to walk through the fence and into the backyard of another home. According to Administrator Gonzalez, she owns the property behind the facility. She stated her staff do take their breaks at the other facility. Administrator Gonzalez stated the fence broke during a storm last week. These violations pose immediate and potential threats to the health, safety, and personal rights of the residents in care. Citations and civil penalties will be issued. An exit interview was conducted; this report was reviewed with Administrator Gonzalez over the phone, and a copy was provided.the state’s words, verbatim · CDSS document, Feb 13, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Feb 13, 2024

FIRE SAFETY: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met, as evidenced by: Based on observation, the Licensee did not ensure the facility was maintained in conformity with the regulations adopted by the State Fire Marshal. The LPA observed a lock on the exterior gate. No secondary exit was available. This posed an immediate threat to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, Feb 13, 2024

Plan of correction: Staff removed the lock from the gate prior to the conclusion of the LPA's visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87202(a)(2) · Plan of correction due date: Feb 14, 2024

FIRE CLEARANCE: (a) All facilities shall maintain a fire clearance approved by... the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the...licensee shall...obtain an appropriate fire clearance approved by...the State Fire Marshal. (2) Bedridden persons. This requirement was not met, as evidenced by: Based on records, the Licensee didn't ensure an appropriate fire clearance was obtained prior to accepting a bedridden person into care. R3's Physician's Report noted R3 is non-ambulatory & bedridden. R3 was unable to reposition themself in bed.the state’s words, verbatim · CDSS document, Feb 13, 2024

Plan of correction: The Administrator stated a copy of a 3-day eviction notice will be submitted to the Department by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 13, 2024

INCIDENTAL MEDICAL AND DENTAL CARE: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe & locked place that isn't accessible to persons other than employees responsible for the supervision of the medication. This requirement was not met, as evidenced by: Based on observation, the Licensee did not ensure refrigerated medications were kept in a safe & locked place. LPA observed medications in the facility's refrigerator. The medications were not maintained secured from any unauthorized individuals.the state’s words, verbatim · CDSS document, Feb 13, 2024

Plan of correction: The Administrator stated a lockbox will be purchased for the medications and a receipt will be submitted to the Department.

Type of visit: Required - 1 Year

On 10/17/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Licensee, Maria Gonzalez who was informed of the purpose of the visit. At the time of visit there was 1 staff and 5 residents present. LPA toured the facility inside and out with Maria Gonzalez. Tour included: Kitchen; LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the census. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen cabinet, available only to authorized individuals. Trash cans has tight-fitting lids. Dishwasher is used to clean and sanitize dishes. Fridge, Freezer, and all need appliances were present and shown to be in working condition and clean. Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 77 degrees Fahrenheit. Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items. Medication; LPA observed medications were labeled and stored in separate bins inside of a locked kitchen cabinet and are distributed according to physician orders. The first aid kit was complete. Continue on LIC809-C Continued from LIC809. Bathroom; LPA toured two #2 out of #2 resident’s bathrooms and observed bathrooms to be clean and equipped with grab bar. There is also a good number of personal toiletries available for the residents in care. Bedroom; LPA toured four #4 out of #4 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility. Garage; LPA tour the garage and observed garage to be clean and not cluttered. Laundry; Laundry supplies are stored away in the garage, inaccessible to clients, washing machine and dryer are all in good repair and sufficient for the census. Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction. No bodies of water were observed. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and Freezer is large enough to accommodate required perishable food. Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Three #3 staff and #3 residents' records were reviewed. All required postings were posted near the entryway and throughout the facility. The administrator certificate expires on 9/26/2024. Interview; one #1 staff and three #3 residents were interviewed. No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Maria Gonzalez.the state’s words, verbatim · CDSS document, Oct 17, 2023