Pioneer Care Home

Type of visit: Required - 1 Year

On 7/20/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit. LPA met with the Direct Care Staff, Joseph Samia and explained the purpose of today’s visit. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. Facility is licensed to serve age 60 and over, 6 non- ambulatory residents of which two (2) may be bedridden and a waiver granted for an approved hospice care for six (6) residents. There are (3) residents in placement and (1) resident in respite placement, whose final day is today. The facility’s annual fees are current. The Pioneer Care Home, Inc is a single-story structure located in a residential neighborhood. The facility consists of (4) bedrooms, (2) bathrooms, living room, kitchen, dining room, office area and an attached garage. The washer and dryer are located in the kitchen. Facility maintains all required posting throughout the facility. LPA conducted a records review of (4) staff records and (4) client records which contained the required documentation, and (4) client medications. LPA Shirley reviewed the Liability Insurance and the Emergency Disaster Plan. LPA Shirley and Joseph walked throughout the facility and common areas such as the living room and dining area were observed. The first aid kit was checked and fully stocked. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature delivered at 114.6 F. LPA observed that there is ample seating and space for all clients. All walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. Smoke/ Carbon Monoxide detectors were operable. There are (2) charged fire extinguishers that were purchased 4/12/25. Exterior areas are clean and clear of obstructions and hazards and there are no bodies of water present. No deficiencies were cited during this inspection visit. An exit interview was conducted, and a copy of this report was provided to Joseph Samia, Direct Care Staff.the state’s words, verbatim · CDSS document, Jul 20, 2026

Type of visit: Required - 1 Year

On 04/17/2025 at 11:00am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Alvin Banzuela, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents of which two (2) may be bedridden and a waiver granted for an approved hospice care for six (6) residents. Three (3) of the residents are diagnosed with dementia, zero (0) receiving home health, and three (3) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money. The facility fees are a balance of $495 due on 06.24.2025. LPA provided pin #386307 with the option for the facility to make an payment online.The facility has liability insurance with Perlas Insurance effective date as 10/28/2024. The home is a single story home consisting of: (4) resident bedrooms, (2) full bathroom, living room, kitchen with dining area, a attached garage and an outdoor shaded patio area in the backyard. Between the hours 11:06am - 11:28am, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 106.5F (in kitchen), 118.2 F (in bathroom #1), 118.0F (bathroom #2). Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Report continues on LIC 809-C Between the hours of 11:29am - 3:15 pm, LPA conducted a records review of (5) residents records, (5) staff records and (5) Client Medication Administration Records and the facility disaster plan. All client & staff records were complete. The facility disaster plan was current (last conducted on 04.10.2025) and in compliance with Title 22 at the time of visit. LPA did not observed any discrepancies at the time of visit. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. An exit interview was conducted Alvin Banzuela, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2025

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 04/17/2025 at 11:00am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today's visit was to conduct the one-year inspection. LPA met with Alvin Banzuela, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents of which two (2) may be bedridden and a waiver granted for an approved hospice care for six (6) residents. Three (3) of the residents are diagnosed with dementia, zero (0) residents receive home health, and three (3) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money. The facility fees are a balance of $495 due on 06.24.2025. LPA provided pin #386307 with the option for the facility to make an payment online. The facility has liability insurance with Perlas Insurance with an effective e date as 10/28/2024. The home is a single home consisting of : (4) resident bedrooms, (2) full bathrooms, living room, kitchen with dining area, a attached garage and an outdoor shaded patio are in the backyard. Between the hours 11 :06am - 11 :28am, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. The water temperature measured at 106.5 F (in the kitchen), 118.2F (in bathroom #1) and 118.0F (bathroom #2). Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards doorways were free of obstructions. Report continues on LIC 809-C Between the hours of 11:29am - 3:15 pm, LPA conducted a records review of (5) residents records, (5) staff records and (5) Client Medication Administration Records and the facility disaster plan. All client & staff records were complete. The facility disaster plan was current (last conducted on 04.10.2025) and in compliance with Title 22 at the time of visit. LPA did not observed any discrepancies at the time of visit. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous Items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During today’s visit LPA did not observe any deficiencies. An exit interview was conducted with Alvin Banzuela (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2025

Allegation investigated: Resident was inappropriately restrained.

On 11/12/2024, at 9:35 AM, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond initiated an unannounced complaint investigation regarding the allegation listed above. During the visit, LPA and LPM met with caregiver Marylou Santos, and later Administrator Alvin Banzuela arrived. The investigation consisted of the following: On 11/12/2024, LPA and LPM interviewed Administrator (A1) via telephone, Staff # 1-3(S1 – S3) and Residents #1-4 # (C1 – C4). LPA was unable to interview Resident #5 due to communication barriers. LPA conducted residents and staff records review and files are incomplete. On 11/12/2024, LPA and LPM did a facility plant tour and observed the following residents rooms #1- #5, bathrooms #1-2, living room, dining room and kitchen. Continues on LIC 9099-C page Substantiated The investigation revealed the following: Allegation: Resident was inappropriately restrained On 11/12/2024, at 9:38 AM, LPA Zina Brown and LPM Janae Hammond interviewed Administrator (A1) Alvin Banzuela via phone regarding the above allegation. A1 stated that he has provided verbal training for the use of gait belts/postural supports. However, he acknowledged that there is no documented training on file for the use of gait belts/postural supports. A1 explained that clients use gait belts, which he believes are part of their wheelchairs and are buckled in front of the client. A1 confirmed there are no physician orders for the use of gait belts. On 11/12/2024, between 10:14 AM and 10:26 AM, LPA interviewed Staff #1-3 (S1-S3) regarding the allegation: All three staff confirmed the use of gait belts for all clients and stated that the gait belts are buckled from behind the clients. Two of the three staff confirmed receiving gait belt training prior to working at the facility. One staff member confirmed receiving training upon hire. Continues on LIC 9099-C On 11/12/2024, between 9:59 AM and 11:51 AM, LPA interviewed Clients #1-4 (C1-C4). All four clients denied the allegations. However, two of the four clients confirmed the use of gait belts. On 11/12/2024, all three staff demonstrated how gait belts are used on clients. The demonstration revealed that gait belts are buckled from behind the clients. On 11/12/2024, at 10:50 AM, LPA reviewed the records for Clients #1-4. No doctor’s orders for the use of gait belts or postural supports were observed. On 11/12/2024, at 11:00 AM, LPA reviewed the personnel records for Staff #1-3. No documentation of employee training was observed. Substantiated: Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted with Alvin Banzuela (Administrator) and copy of the report and appeal right were provided.the state’s words, verbatim · CDSS document, Nov 12, 2024 · control 11-AS-20241104100324

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 15, 2024

. . .(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment Based on observation & interview, the facility staff is utilizing a gait belt that is buckled behind the resident which does not the resident to release them from chair.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: The licensee/administrator shall provide staff training on the proper use of gait belt. Training will be documented in the staff file & the copy of the training will be submitted to the department by POC due date.

Allegation investigated: Resident was inappropriately restrained.

On 11/12/2024, at 9:35 AM, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond initiated an unannounced complaint investigation regarding the allegation listed above. During the visit, LPA and LPM met with caregiver Marylou Santos, and later Administrator Alvin Banzuela arrived. The investigation consisted of the following: On 11/12/2024, LPA and LPM interviewed Administrator (A1) via telephone, Staff # 1-3(S1 – S3) and Residents #1-4 # (C1 – C4). LPA was unable to interview Resident #5 due to communication barriers. LPA conducted residents and staff records review and files are incomplete. On 11/12/2024, LPA and LPM did a facility plant tour and observed the following residents rooms #1- #5, bathrooms #1-2, living room, dining room and kitchen. Continues on LIC 9099-C page Substantiated The investigation revealed the following: Allegation: Resident was inappropriately restrained On 11/12/2024, at 9:38 AM, LPA Zina Brown and LPM Janae Hammond interviewed Administrator (A1) Alvin Banzuela via phone regarding the above allegation. A1 stated that he has provided verbal training for the use of gait belts/postural supports. However, he acknowledged that there is no documented training on file for the use of gait belts/postural supports. A1 explained that clients use gait belts, which he believes are part of their wheelchairs and are buckled in front of the client. A1 confirmed there are no physician orders for the use of gait belts. On 11/12/2024, between 10:14 AM and 10:26 AM, LPA interviewed Staff #1-3 (S1-S3) regarding the allegation: All three staff confirmed the use of gait belts for all clients and stated that the gait belts are buckled from behind the clients. Two of the three staff confirmed receiving gait belt training prior to working at the facility. One staff member confirmed receiving training upon hire. Continues on LIC 9099-C On 11/12/2024, between 9:59 AM and 11:51 AM, LPA interviewed Clients #1-4 (C1-C4). All four clients denied the allegations. However, two of the four clients confirmed the use of gait belts. On 11/12/2024, all three staff demonstrated how gait belts are used on clients. The demonstration revealed that gait belts are buckled from behind the clients. On 11/12/2024, at 10:50 AM, LPA reviewed the records for Clients #1-4. No doctor’s orders for the use of gait belts or postural supports were observed. On 11/12/2024, at 11:00 AM, LPA reviewed the personnel records for Staff #1-3. No documentation of employee training was observed. Substantiated: Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted with Alvin Banzuela (Administrator) and copy of the report and appeal right were provided.the state’s words, verbatim · CDSS document, Nov 12, 2024 · control 11-AS-20241104100324

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 15, 2024

. . .(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment Based on observation & interview, the facility staff is utilizing a gait belt that is buckled behind the resident which does not the resident to release them from chair.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: The licensee/administrator shall provide staff training on the proper use of gait belt. Training will be documented in the staff file & the copy of the training will be submitted to the department by POC due date.

Type of visit: Case Management - Deficiencies

On 11/12/2024 at 9:35am, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced case management deficiencies. During the complaint investigation, LPA observed residents and staff records are incomplete, Staff #3 is not associated to the facility and Resident #2 - Resident #5 have bed rails but there are no physician orders on file. The facility staff are using gait belts for residents #1- resident #5 there are no physicians order. Civil penalties assessed and the decencies cited under California Code of Regulation Title 22, Division 6, Chapter 8 are being cited on the LIC 809-D. Exit interview conducted with Alvin Banzuela, Administrator and a copy of this report was provided with appeal rights.the state’s words, verbatim · CDSS document, Nov 12, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Nov 13, 2024

Request a transfer of a criminal record clearance as specified in Section 87355(c) or . . Based on records review, Staff #3 is not associated to the facility poses as a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: The licensee/administrator will associated Staff #3 in guardian or submit criminal record transfer request to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(3) · Plan of correction due date: Dec 4, 2024

A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. Based on records review and observation, Resident #2-#5 have half bed rails but no physician order on file which poses as a personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: The licensee/administrator will obtain physician order and submit a copy to the department by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Dec 12, 2024

The licensee shall ensure that a separate, complete, & current record is maintained for each resident in the facility. . . Based on records review and observation, Resident #1 - #5 records were incomplete which poses as a health and safe risk to residents in carethe state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: The licensee/adminstrator will ensure all resident records are complete and ready for licensing review by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a) · Plan of correction due date: Dec 12, 2024

The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. . . Based on records review and observation Staff #1-Staff #3 personnel records were incomplete which poses a potential health and safety risk to the residents in carethe state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: The licensee/adminstrator will ensure all staff records are complete and ready for licensing review by POC due date.

Type of visit: Prelicensing

On 06/13/2024 at around 10:00 AM Licensing Program Analyst (LPA) Leandro conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA met with Administrator Alvin Banzuela. On 03/01/2024 an application was submitted to CCLD, for Initial license for a Residential Care Elderly Facility to serve adults ages 66 and above. The facility was approved for a capacity of 8 people. There may be 6 non-ambulatory residents and 2 bedridden residents in this facility. The facility is a one-story house located on a residential street. The facility is composed of 4-bedrooms, 2-bathrooms, 1-office, 1-kitchen/common room area, 1-dining room, 1-backyard deck, 1-attached garage. LPA conducted a review of the Physical Plant, Bedrooms, Bathrooms, Supplies, Food Service, Medications, Records, Administration, Activities, Pe-Licensing Checklist and Component III Orientation. MEDICATIONS There is a locked centralized storage area for resident medications. PHYSICAL PLANT Facility is clean, sanitary, and in good repair. Protective devices are in place to include nonslip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Fireplaces and open-faced heaters are inaccessible to residents. Stairways, inclines, ramps, open porches, and areas of potential hazard are well-lit and equipped with sturdy hand railings. Fire Alarms and Smoke alarms operate properly. Carbon monoxide detectors operate properly. BEDROOMS Halls, stairways, unfinished attics or basements, garages, storage areas, and sheds, or similar detached buildings are not being used as resident bedrooms. Resident bedrooms are large enough to allow for easy passage and to accommodate furniture and assistive devices such as wheelchairs, walkers, or oxygen equipment. No resident bedroom is a passageway to another room, bath or toilet. There is a bed for each resident with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. Mattresses and pillows are flame-retardant. There is dresser and closet space for each resident that includes at least two (2) drawers or eight (8) cubic feet of dresser space per resident. There is a chair and lamp for each resident and at least one (1) nightstand per two (2) residents. BATHROOMS There is at least one (1) toilet and washbasin per six (6) residents, family, and personnel. There is at least one (1) shower or bathtub per ten (10) residents, family, and personnel. Hot water temperature is between 105-120 degrees Fahrenheit. Bathroom is located near resident bedrooms. There are nightlights in the hallways outside non-private bathrooms. SUPPLIES There are resident personal hygiene supplies to include feminine napkins, soap, toothpaste, toilet paper, and comb. There is a sufficient supply of clean linens to permit weekly changing or more of resident top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0 degrees Fahrenheit. Refrigerator is a maximum of 45 degrees Fahrenheit. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage of personnel records at the facility. There is confidential storage of resident records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Resident Personal Rights are posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES An activities calendar is posted. There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to residents for visitors. There are activity supplies to include newspapers, magazines, and a variety of reading material. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to residents. Emergency lighting and supplies to include flashlights with batteries. Vehicles used to transport residents are in safe operating condition. PRE-LICENSING CHECKLIST Completed by licensee and reviewed by LPA. COMPONENT III Information was provided about how to operate the facility within substantial compliance. An exit interview was conducted, and a hard copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to the applicant.the state’s words, verbatim · CDSS document, Jun 13, 2024