Palms Bay Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Eddie Agnote after introducing self and stating the reason for the visit. Administrator's Assistant (Admin Asst.) Mary Christine Alfaro followed by Administrator Claudia Olteanu shortly arrived to assist with the inspection. Administrator Claudia Olteanu has a valid certificate expiring on June 13, 2026. The following was observed during the inspection accompanied by Caregiver Agnote: This is Residential Care Facility for the Elderly (RCFE) vendorized by the Regional Center of Orange County. This is a level 6 home. The facility is located in a residential neighborhood comprised of four private resident bedrooms and two resident full bathrooms. LPA observed four residents in care, none of which are currently on hospice and bedridden. LPA observed three staff present and two on duty. Facility is operating within the conditions and limitations specified on the license. LPA toured the physical plant. LPA inspected all common areas including the attached two car garage and all resident bedrooms. The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. Facility appeared clean, sanitary, and in good repair as well as the bathrooms. Slip resistant mats were observed to be available. The hot water temperature in the resident bathrooms measured within range measuring at 118.0 and 118.5 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The Additional Dwelling Unit (ADU) is approved per the fire clearance. LPA observed two bedrooms and one bathroom designated for staff. The outdoor passageway is free of obstruction, and there are sufficient seating and shading in the patio area. There are no bodies of water on premise and two sheds are secured and inaccessible. The first aid kit contains all necessary elements. The two fire extinguishers were mounted, charged, and serviced on January 22, 2026. The auditory devices and smoke/carbon monoxide detectors were tested and operational in all areas. Facility maintains emergency food, water. and disaster supplies. A working telephone (714) 583-8555 was tested and remains available. Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the entry way in the correct size. LPA reviewed four residents and two personnel files. No discrepancies noted. Present staff are background cleared and associated to the facility. Staff met their annual 40 and 20 hour training. The Emergency Disaster Plan (LIC610E) was reviewed. Disaster drills of various scenarios are conducted quarterly with the last known date was April 14, 2026. Medications were audited for two of four residents. Admin will verify the order for a medication for Resident #1 (R1). Based on the observations made during today's visit, no deficiency is being cited. An exit interview was conducted with Administrator Claudia Olteanu and Administrator's Assistant Mary Christine Alfaro, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, May 22, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA met with Applicant Abel Marica and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on September 05, 2024. The facility is to have a capacity of six residents, (1) ambulatory, (4) non-ambulatory and (1) bedridden residents. Applicant requested a Hospice Waiver for (6). Facility phone number is 714-583-8555. LPA observed the following. Structure: The facility is a one-story house with four resident bedrooms, two full size bathrooms, a living room, a kitchen, a dining room, and a garage Accessory Dwelling Unit. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall by entryway. There is one gate by the front entrance. There is a shaded seating area and LPA did not observe any obstacles or hazards in the backyard. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are four resident bedrooms. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. CONTINUED ON LIC809-C... Bathrooms: All bathrooms are clean and have working plumbing. Hot water measured between 111.2-113.1 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen for each resident was stored in the closet by the residents' bedroom hallway. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menu was posted and available. Menu available and posted on the board. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors are hardwired and tested operational. Fire extinguishers were charged, mounted and one was located by the entryway and one by the residents' bedroom hallway. Appliances: There is one gas stove, one oven, microwave oven mounted above the stove, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored in locked cabinets under the kitchen and restroom sinks. Water Temperature: Hot water was measured in all bathrooms. Hot water measured between 111.2-113.1 degrees Fahrenheit. Medications, First-Aid Kit & Book: The first aid kit and the first aid manual are stored in a cabinet next to the dining room. The first aid kit has all the required elements. Medications will be stored in locked cabinet next to dining room. Resident & Staff Files: The resident and staff records will be kept in a locked cabinet in the living room. Reading Material, Games, Equipment & Materials: The activities plan include playing card games, books, newspaper reading and outings. Fire clearance: Fire Clearance approved by a fire inspector of Orange County Fire Authority on November 20, 2024. Special conditions noted, "Garage ADU approved for staff only; no client use. All bedrooms approved for ambulatory clients. Bedroom 1: Non-ambulatory. Bedroom 2: Non-ambulatory or bedridden. Bedroom 3: Non-ambulatory." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. LPA advised Applicant to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for inquiries and to submit incident reports. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Central Applications Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, Apr 15, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Abel Marica (Board Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On March 12, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 12, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Claudia Olteanu (CEO/Administrator) Interview Method: Virtual interview via Microsoft Teams On March 03, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 3, 2025