Pedrose Home Care

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 01/29/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Pedro Pancho. A brief interview was conducted with the facility designated Administrator at this time. Current census was 3 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 10/31/2025. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 10/31/2025: A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Bedridden persons A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst, LPA, Noel Wolf Petersen and Licensing Program Manager, LPM, Liza King arrived unannounced at 10:45am to conduct an annual inspection. Pedrose Home Care, is a 6 capacity facility for 5 nonamb and 1 bedridden. There is 3 resident on hospice, 2 residents who are bedridden and 3 residents with dementia. Facility is observed to have 2 bedridden clients, operating outside the license and beyond the buildings fire clearance, citations issued on following d-page. Physical Plant inspection was conducted including but not limited to kitchen, common areas, bedrooms, bathrooms, storage areas, staff room, exteriors, and evacuation routes. facilility is clean and traffic areas are unobstructed and well lit. Kitchen, has adequate food supply 2 days perishable, 7 days non perishable. Sharps, Medications, are stored locked. common areas and exterior have space for activities and free of trip hazards. Evacuation route gate is in good repair, swings freely and latches closed. bathrooms have functioning hardware, water is delivered within range 105-120*F. Bedrooms have required furniture and furnishings, mattresses are have rubber encasements. Continued on c Page. Smoke/Co alarm was functional, Fire extinguisher was dated 6/9/25, first aid kit is complete. air temp is 69*f. 4 of 4 client files are not up to date, 2 of 3 hospice care plans not present, however interview with administration showed not familiar with hospice care plans. 4 of 4 needs and services care plans were not individualized and/or present. citation issued on following d-page. 3 of 5 Staff files contain up to date cpr/ first aid, finger printing, guardian association, and initial training. partial continuing training 12/20 hours completed for the year 2025. Administrator was advised hospice can provide free additional training(medication administration/documentation) specific to dementia/hospice care. citation was given on following d-page. Clients have no P+I. Safeguarded property forms are not filled out for all clients, Technical violation was issued. 2 staff was interviewed, 2 clients were interviewed. Medication and mars were reviewed for 2 clients at random: there are no start dates on medications, mars are not up to date with the administrated medications for the past 3 days, the prn/refusal documentation does not have required information, the disposal documentation exists but doesn't apply to any residents currently in the facility who have had medications discontinued. LPA gave guidance that the administrator should assert a role of care giving with the clients at a level where they can call the doctors of the clients directly in the event that changes in care need to be responded to. One client has medications stored outside their original containers. Citations were given on following d-page. Administrator files were reviewed: fire drill record doesn't exist, liability insurance is up to date, no need for surety bond, refund and theft and loss policy exists in the plan of operation, property control exists via grant deed, 308 does not designate a person, secretary of state is expired. Citation issued on following d page. LPA is requesting an updated 200(for 2 bedridden), facility sketch(for 2 bedridden), 308(designating a substitute administrator), and a copy of up to date workers comp insurance, filings with secretary of state, safeguarded property for all clients. LPA is giving guidance that an outside agency should give the training for medication documentation and administration. Copy of the report was read and given to the administrator. exit interview was conducted. citations were given as part of this visit. appeal rights were provided. TSP refferal was offered.the state’s words, verbatim · CDSS document, Oct 31, 2025

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 01/06/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Pedro Pancho, at this time. A brief interview was conducted with the facility designated Administrator at this time. The purpose of this visit was to follow up on the deficiencies that were cited on a prior annual visit dated on 12/02/2024: Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment. The Plan of Correction was reviewed and clearance letter was printed out and a copy was given to the facility designated Administrator at this time. There were no deficiencies observed or cited during today's visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 6, 2025

Type of visit: Required - 1 Year

Unannounced Annual visit made out to this facility on 12/02/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Pedro Pancho, who was briefly interviewed at this time. Current census was 3 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (6) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. It was learned that there were (3) residents diagnosed with dementia at this time. It was learned that there weren't any residents receiving services through home health at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry room, located prior to the entrance for the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, #7026619740, for Pedro Pancho was observed to have an expiration date of 10/26/2025 and in compliance at this time. Forms and documents have been completed in order to renew this Administrator certificate at this time. Medication cabinet, located in the facility entry hallway cabinets, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the medication cabinet, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguisher, located in the kitchen area, was observed to have been annually reviewed by the local fire authority, Butch Young Fire, on 08/26/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (3) facility personnel records was conducted on the LIC 859. A review of (3) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 2, 2024

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 12/07/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Pedro Pancho, at this time. A brief interview was conducted with the facility designated Administrator at this time. The purpose of this visit was to follow up on the deficiencies that were cited on a prior annual visit dated on 11/27/2023: An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. 1. Initial training requirements for new facility staff shall be addressed in the plan, with training to be provided by the Infection Control Lead before staff works independently with residents. An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan. 2. Ongoing training requirements for all facility staff shall be addressed by the plan, with training to be provided by the Infection Control Lead. The Plan of Correction was reviewed and clearance letter was printed out and a copy was given to the facility designated Administrator at this time. There were no deficiencies observed or cited during today's visit. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 7, 2023

Type of visit: Required - 1 Year

Announced Annual visit made out to this facility on 11/27/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Pedro Pancho, at this time. A brief interview was conducted with the facility designated Administrator at this time. It was learned that this facility was licensed for a total of (6) residents, of which, all (6) could be nonambulatory. This facility is licensed to be able to retain (1) bedridden resident with a hospice waiver approved for (6) residents. Current census was 2 residents. There was (1) resident under the care of hospice at this time according to statements made by the facility designated Administrator. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the facility entry way, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in compliance at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Laundry room was observed to be locked with the detergents, soaps, and bleach products were properly stored at this time. It was learned that all cleaning and laundry supplies were separately locked and made inaccessible to the residents at all times. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. First aid kits were observed to be present and contained all of the required components at this time. Fire extinguisher was observed to be placed in the kitchen area and was just recently purchased and found to be in compliance at this time. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (2) facility resident files was conducted and noted on the LIC 858. A review of (3) facility staff files was conducted and noted on the LIC 859. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 27, 2023