Pilgrims Guest Home

Type of visit: Required - 1 Year

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by care giving staff. LPA explained the purpose for the visit, and Administrator (AD) Nomita Vibar was notified via phone call. AD arrived shortly after to assist LPA with annual inspection. LPA began a tour of the facility and observe the following. AD has an active Administrator certificate valid from The facility is a single storied home with five bedrooms, one of which is a staff room and four of which are resident rooms. The facility is equipped with two bathrooms, and a detached two car garage. LPA observed kitchen area to be clean and free of any mildew and debris. LPA observed a refrigerator, gas stove, dishwasher and microwave located in the kitchen area. All appliances tested operational and appeared in good repair. LPA observed all hazards, sharps and medications to be locked away and inaccessible to residents in care. LPA observed a two day supply of perishable food and a seven day supply of non-perishable food along with a sufficient amount of emergency water on hand. LPA observed all resident rooms to be clean and free of any mildew and debris. LPA observed all reooms to be free of any obstructions and hazards. LPA observed all rooms to be large enough to walk about freely and consist of all required furnishings including a chair, a bed, clean linens in good repair; meaning no strains or tares, a reading lamp, a chest of drawers, and enough storage space to store all personal belongings. LPA observed resident restrooms to be clean and free of any mildew and debris. LPA observed water faucets and toilets to be operational. LPA observed restrooms to have all required furnishings such as a shower chair, slip resistant matts, and grab bars. Hot water temperature tested between 104.3 and 106.5 degrees Fahrenheit. CONTINUED ON LIC809-C LPA observed all smoke detectors and carbon monoxide detectors to be in good repair and tested operational. LPA observed the fire extinguisher in the kitchen area to be fully charged but not have an updated service tag attached to it. A deficiency was issued on today's date. LPA observed first aid kit to have all required items in it including bandages, scissors, tweezers, adhesive tape, a thermometer, and a first aid manual. LPA toured the outside of the facility and observed for the backyard to be large enough to participate in outdoor activities upon resident request. LPA observed an outdoor shaded sitting area, and for the backyard to be free of any obstructions along the side exit routes. Side doors are unlocked and self latching. LPA reviewed four resident files and three staff files. All files (staff and resident) had all required documents and staff annual training was documented and completed. LPA reviewed P&I with AD and observed all balances to be documented correctly and matched the cash on hand. LPA reviewed medications accompanied by AD and per LPA review all medications are being documented correctly and medications are being administered per physicians orders. No discrepancies were observed. Based on observations made during today's inspection deficiencies will be issued per title 22 chapter 6 division 8 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Required - 1 Year

On September 22, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by the Administrator (AD) Normita Vibar. For this visit, there are three staff members on duty, including AD, Co-administrator, and caregiver, all of which are background cleared and associated. AD assisted with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located by the front entrance. LPA observed the Administrator's Certificate for Normita Vibar, which expires on June 5, 2026. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and one of which may be on hospice. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of four ambulatory residents in care, none of which are on hospice or are bedridden. The facility is a single-story home. There are a total of five bedrooms, four of which are private resident rooms, and one serves as staff quarters. LPA toured each bedroom with the AD and observed bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff quarters to be kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of two bathrooms, both of which are for residents and staff. Continued on LIC 809-C. Restrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the restrooms were measured to be between 110.4 and 115.5 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguishers were dated and tagged on April 7, 2025. LPA observed the emergency disaster and evacuation plan, which is posted in the hallway. Facility had back-up emergency food and water supply, located in the garage and the hallway. LPA observed that the First Aid kit had all the required components. Medications and toxins were also observed to be locked in a cabinet in the kitchen, inaccessible to residents in care. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards or obstructions. There are two self-latching gates in the backyard that can be opened in case of an emergency. No bodies of water were observed. Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Normita Vibar. This report was reviewed with the administrator and a copy was provided at the end of the visit.the state’s words, verbatim · CDSS document, Sep 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Licensee/Administrator Normita Vibar who arrived a short time later and was present for the remainder of the of the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had the necessary elements and were in compliance with regulation guidelines. Resident bathrooms were clean and organized. Hot water temperatures were measured in the range of 111.2 degrees Fahrenheit and 114 degrees Fahrenheit. No hazardous items were observed in the resident bathrooms, and all grab bars were tightly secured to the wall. There’s a locked closet in the hallway with emergency items prepared and ready to go. An emergency food and water supply was observed as well. There was another cabinet in the hallways with a supply of linens, and the carbon monoxide detector is mounted on the ceiling in the hallway. The kitchen was clean and organized. Knives and sharp objects are kept locked in a drawer near the sink. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. Resident medications are locked in a cabinet. There’s a small laundry area in between the kitchen and the backyard exit and bathroom with a washer and dryer. There is a locked cabinet with hazardous cleaning chemicals and laundry detergents. There’s a fully charged fire extinguisher mounted on the wall in the laundry area. In between the living room and the backyard there’s an addition room. The room is used as an activity room and private visiting area if needed. In the activity room, there’s a locked cabinet used to store staff and resident files, and resident P&I funds. Continued on LIC809C The garage is used to store various items. There were clear walkways and in the middle of the garage there were several boxes and other items being stored. There's a deep freezer with an additional perishable food supply, and an additional non-perishable food supply observed on the shelves. There was a locked cabinet with an additional supply of hygiene items, and some hazardous cleaning items. The backyard was clean, organized, and walkways were free of obstruction. Two shaded patio areas with tables and chairs were observed. One of two side exit gates is self closing and self latching. An emergency evacuation drill was conducted March 5, 2024 and will continue to be conducted quarterly for staff on each shift. Smoke detectors, and the carbon monoxide detector tested operational. During the visit an audit of all resident medications and P&I funds was completed. No deficiencies are being cited as a result of today’s visit. An exit interview was conducted, and a copy of this report was provided to Licensee/Administrator Normita Vibar.the state’s words, verbatim · CDSS document, Jun 7, 2024