Modesto Guest Home

Type of visit: Required - 1 Year

On 04/20/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct an Annual Visit. LPA Pascua was greeted by Facility Designated Administrator (FDA) Guillermina Zepeda and explained the purpose of the visit. Current census was 28. A brief interview was conducted with FDA Zepeda. This facility is licensed for 31 residents, of which 25 may be non-ambulatory. LPA reviewed 5 resident files. 5 out of 5 resident files were current and up to date. LPA reviewed 6 staff files. 6 out of 6 staff files were current and up to date. The facility Administrator has an administrator certificate #7007849740 and expires on 03/21/2027. LPA Pascua observed a locked centralized stored medication cabinet located in the office. Along with the staff member, the LPA observed, reviewed, and compared resident medication and electronic medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour with FDA Zepeda was conducted. Fire extinguisher located throughout the facility were out of compliance at this time. Carbon monoxide, smoke detectors and call lights were observed to be in good repair. This facility conducted their last fire drill on 04/06/2026. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care. Additional food supply was identified in an outside storage. A tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents at this time. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A tour of the second building was conducted. Dining areas, living areas, and all other areas intended for resident use were toured in this building. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 An immediate civil penalty was issued for Section 87203 for not ensuring that the fire extinguishers have been serviced within the last year. Per California Code of Regulations, Title 22 Division 6, Chapter 8, one deficiency is being cited today in violation of California Code of Regulations. An exit interview was conducted, a copy of this report and appeals rights were provided to the Administrator at the end of this visitthe state’s words, verbatim · CDSS document, Apr 20, 2026

Allegation investigated: Staff did not prevent a resident from threatening another resident in care.

On 05/13/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Giullermina Zepeda and explained the purpose of the visit. The purpose of this visit was to inform the facility and it's representative that a complaint has been filed against it at this time. Current Census was 28. A tour of the facility was conducted. During the course of the tour, LPA conducted staff and resident interviews and reviewed facility records. Based on the interviews conducted during the course of this visit, it was admitted that R1 will threaten R2 with comments such as "Shut up, 'F' YOU. It was stated that this will happen from time to time and the facility staff have been notified however there have been no ramifications regarding R1's behavior towards R2. Based on the information gathered, staff did not prevent a resident from threatening another resident in care. Substantiated Based on observations, review of records and information gathered through interviews, the above allegations were SUBSTANTIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged. The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulation. An exit interview was conducted, a copy of this report and appeals rights were provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, May 13, 2025 · control 27-AS-20250507153854

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 13, 2025

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This is not met as evidenced by: Based on interview and record review, the facility did not ensure that R2 was accorded with dignity with their roommate. It was admitted by staff that they are aware that R1 would make comments towards R2. This poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, May 13, 2025

Plan of correction: Administrator states that a plan will be put in place to ensure that R2 feels comfortable in their room. This plan shall be submitted to the LPA for review by POC date.

Type of visit: Required - 1 Year

On 04/20/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct an Annual Visit. LPA Pascua was greeted by Facility Designated Administrator (FDA) Guillermina Zepeda and explained the purpose of the visit. Current census was 27. A brief interview was conducted with FDA Zepeda. This facility is licensed for 31 residents, of which 25 may be non-ambulatory. LPA reviewed 5 resident files. 5 out of 5 resident files were current and up to date. LPA reviewed 6 staff files. 6 out of 6 staff files were current and up to date. The facility Administrator has an administrator certificate #6025364740 and is awaiting renewal from the department. LPA Pascua observed a locked centralized stored medication cabinet located in the office. Along with the staff member, the LPA observed, reviewed, and compared resident medication and electronic medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour with FDA Zepeda was conducted. Fire extinguisher located throughout the facility. was serviced by U.S.A. Stanislaus Fire on 07/29/2024 and is in compliance at this time. Carbon monoxide, smoke detectors and call lights were observed to be in good repair. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care. Additional food supply was identified in an outside storage. A tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents at this time. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A tour of the second building was conducted. Dining areas, living areas, and all other areas intended for resident use were toured in this building. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies are being cited today in violation of California Code of Regulations. An exit interview was conducted, a copy of this report and appeals rights were provided to the Administrator at the end of this visit.the state’s words, verbatim · CDSS document, Apr 30, 2025

Type of visit: Required - 1 Year

On 04/26/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA met with Facility Designated Administrator (FDA), Guillermina Zepeda and explained the purpose of the visit. Current census was 26. A brief interview with FDA Zepeda was conducted. This facility is licensed for 31 residents, of which 25 may be non-ambulatory. A tour with FDA Zepeda was conducted. Fire extinguisher located throughout the facility. was serviced by U.S.A. Stanislaus Fire on 06/29/2023 and is in compliance at this time. Carbon monoxide, smoke detectors and call lights were observed to be in good repair. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that there only one couch available able to sit 2-3 residents at a time and 4 plastic chairs around the common area. Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care. Additional food supply was identified in an outside storage. A tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents at this time. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. It was observed that the resident bathrooms had cracked tiles near the drainage area, and had baseboards around the shower area to have been lifting. It was advised at this time the facility does not use this bathroom until this has been repaired. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A tour of the second building was conducted. Dining areas, living areas, and all other areas intended for resident use were toured in this building. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. . The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. Due to insufficient time to conduct records review, the LPA will return at a later date to continue the annual visit. A technical advisory was provided for 87555(26)(b). Per California Code of Regulations, Title 22 Division 6, Chapter 8, one deficiency is being cited today in violation of California Code of Regulations. An exit interview was conducted, a copy of this report and appeals rights were provided to the Administrator at the end of this visit.the state’s words, verbatim · CDSS document, Apr 26, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(1) · Plan of correction due date: May 27, 2024

(1) Sufficient room shall be available to accommodate persons served in comfort and safety. This is not met as evidenced by: Based on observation the Licensee did not ensure that the facility had a sufficient amount of space and furnishings to ensure that resident's are able to sit in common areas. LPA observed one couch only only able to sit 2-3 residents and 4 plastic chairs around the tv room. This poses an potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2024

Plan of correction: Licensee shall provide a statement of correction and acknowledgement to the LPA by the POC date. Licensee shall also provide additional sitting areas for the residents and provide a picture to the LPA by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Apr 26, 2024

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This is not met as evidenced by: Based on observation and interview, the Licensee did not ensure that the facility bathroom has been in good repair. LPA observed a large crack in the resident restroom used in the front building along with the baseboards peeling away from the wall. This poses a potential health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2024

Plan of correction: Licensee shall provide a plan in place to fix and maintain bathrooms by POC date. Any purchases or services rendered must be relied to the LPA by the POC date.