Positive Directions #9

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) B. Miranda conducted an unannounced visit today August 3, 2026 for the facility’s annual inspection. LPA introduced themselves and was allowed entrance into the facility. LPA met with Administrator Maria “Alicia” Ortiz. Facility is licensed for 4 residents and has a current census of 4. There are 0 residents on hospice and 0 with home health. Water temperature was checked in the kitchen and read at 105.3 degrees Fahrenheit. Fire Extinguisher was serviced August 5, 2025 and is within the safety regulation period. Smoke and carbon monoxide detectors were tested and in working order. Alicia’s Administrator Certification expires November 24, 2027. Staff files were reviewed, are complete, and current. Resident files were reviewed, complete, and current. Facility provided a log for disaster drills that are conducted monthly. First aid kit on site. Toxins and cleaning supplies are locked and inaccessible. There is a locked storage for medications. Sample of medication was checked. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms, bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean, properly furnished, with adequate lighting, and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA is requesting the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing August 14, 2026. Exit interview conducted and a copy of this report LIC809 was provided to Alicia Ortiz.the state’s words, verbatim · CDSS document, Aug 3, 2026

Type of visit: Required - 1 Year

On 08/19/25, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by staff, stated the purpose of the visit and was allowed entry into the facility. Administrator was called and arrived to the facility shortly after. Administrator on record is Maria Alicia Ortiz certification # 7033833740 Expires 11/24/25. LPA observed no residents in care at the time of visit as they were all attending day program. Facility is a 4 bedroom 2 bathroom home. There is a designated office to right of the entry. Bathrooms were observed to have grab bars by the toilets and a grab bar in the shower used by residents. Residents in care receive Regional Center services. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. LPA toured the facility inside and out and observed the facility temperature read at 72 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Facility bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at degrees F. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. A supply of extra linens were observed in the hall closet. Cleaning supplies were observed to be locked in a kitchen cabinet under the sink . LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Covered trash cans with lids were observed throughout the facility. Hand washing postings were observed. Carbon monoxide and smoke detector were observed to be operational. Outside of facility was toured and observed to be clean and free from obstruction. A self-closing and self-latching gate for emergency exit was observed. First aid kits were observed to contain all required items. Medications were observed to be locked in a cabinet located in the office. Quarterly Emergency Disaster Drill logs were observed for staff. A sample of resident and staff files were reviewed and observed to have the required forms and training records. The following documents are requested to be updated and submitted to Fresno CCL by: 08/29/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Proof of Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A). An exit interview was conducted with Administrator. A copy of this report and provided at the time of visit. No Deficiencies cited on today's visit. (Continue LIC 809-C) The following documents are requested to be updated and submitted to Fresno CCL by: 08/29/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Proof of Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A). An exit interview was conducted with Administrator. A copy of this report and provided at the time of visit.the state’s words, verbatim · CDSS document, Aug 19, 2025

Type of visit: Case Management - Incident

LPAs K.Kaur and L. Salazar questioned Administrator regarding incident report dated 11/1/2024 regarding Resident 1 (R1). Cross Report received from Day Program indicated change in condition for resident was reported to "House Manager" (Patricia) S1. Review of Facility Personnel Report Summary did not have House Manager S1 listed. Administrator provided LPAs proof of finger print clearance for S1, however, review of Guardian and Licensing Information System shows S1 is not associated to the facility. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6 and an immediate civil penalty is being assessed in the amount of $500. An exit interview was conducted with Administrator Alicia Maria Ortiz. Report signed on-site by Administrator, whose signature on the form confirms receipt of this document.the state’s words, verbatim · CDSS document, Dec 16, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(c) · Plan of correction due date: Dec 17, 2024

87355 Criminal Record Clearance (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department: This requirement is not met as evidenced by: Based on file review; House Manager S1 is not associated with the facility.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Licensee to associate staff immediately or submit documents to CCLD office by due date.

Type of visit: Case Management - Deficiencies

On 12/16/24, Licensing Program Analysts (LPAs) L. Salazar and K.Kaur arrived to the facility unannounced to conduct a case management visit based on a self reported incident received 10/14/24. LPAs were greeted by staff Diana Cervantes, stated the purpose of the visit and were allowed entry into the facility. Administrator Maria "Alicia" Oritz arrived to the facility shortly after. On 10/14/24, LPA Salazar received a death report for Resident R1. LPA Salazar reviewed R1's file and observed the following missing documentation at the time of R1's admission on 10/08/24: 1.) Pre-Admission appraisal; 2.) Medical Assessment ; 3.) Functional capabilities; reassessment and Identification and Emergency information. Emergency information observed did not include the Names, address, and telephone numbers of the resident’s representative, as defined in Section 87101(r), to be notified in case of accident, death, or other emergency. On 10/08/24, Resident R1 was placed by Kern Regional Center as an emergency placement. On 10/09/24, R1 was admitted to the hospital on with a diagnosis of hypothermia and lactic acidosis. R1 was discharged from the hospital on 10/11/24 and died in the car on the way home from Delano Regional Hospital. No reassessment was completed or observed from the 10/11/24 hospital discharge. LPA requested staff records on 10/15/24. Administrator stated staff files were at the office and would be sent via email to LPA. LPA received records on 10/30/24, 15 days after the request. Based on observation and records review and Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 809-D. If not corrected, these pose both an immediate and potential risk to the health, safety and/or personal rights of the residents in care. Plans or corrections were developed by Administrator and reviewed with LPA, with a due date of 12/17/24. An exit interview was conducted. A copy of this report and appeal rights were provided at the time of visit. Technical Support Program was offered and accepted.the state’s words, verbatim · CDSS document, Dec 16, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87457(a)(1) · Plan of correction due date: Dec 16, 2024

87457 Pre-Admission Appraisal - General (a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. (1) Sufficient information about the facility and its services shall be provided to enable all persons involved in the placement to make an informed decision regarding admission. This requirement was not met as evidenced by LPAs observation of Resident R1's file. No preadmission appraisal was observed in file or conducted prior to R1's admission. This poses an immediate risk to the health, safety and or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87458(a) · Plan of correction due date: Dec 16, 2024

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement was not met as evidenced by LPAs observation of Resident R1s file. No medical assessment was obtained prior to admission not observed in file. This poses an immediate risk to the health, safety and or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(g)(1) · Plan of correction due date: Dec 20, 2024

87412 Personnel Records (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. (1) The licensee shall be permitted to retain such records in a central administrative location provided that they are readily available to the licensing agency at the facility as specified in Section 87412(f). This requirement was not met as evidenced by LPAs request for staff records on 10/15/24. Administrator stated staff files were at the office and would be sent via email to LPA. LPA received records on 10/30/24, 15 days after the request. This poses a potential risk to the health, safety and/or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(b)(8) · Plan of correction due date: Dec 20, 2024

87405 Resident Record (b) Each resident’s record shall contain at least the following information: (8) Names, address, and telephone numbers of the resident’s representative, as defined in Section 87101(r), to be notified in case of accident, death, or other emergency. This requirement was not met as evidenced by LPAs observation of R1 files. Records obtained at the time of admission did not include the required information.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87455(c)(2) · Plan of correction due date: Dec 17, 2024

87455 Acceptance and Retention Limitations (c) No resident shall be accepted or retained if any of the following apply: (2) The resident requires 24-hour, skilled nursing or intermediate care as specified in Health and Safety Code Sections 1569.72(a) and (a)(1). This require was not met as evidenced by LPAs observation of R1's records facility obtained at the time of initial admission on 10/08/24 and readmission from hospital on 10/11/24. Based on interviews, R1 had conditions that facility was not aware of and the hospitalization records and death certificate are evidence of the medical conditions that were not disclosed or observed at the time of admission. R1 was not assessed at the time of admission on 10/08/24 and also readmission on 10/11/24. This poses an immediate risk to the health, safety and or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87463(a)(3) · Plan of correction due date: Dec 27, 2024

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement was not met as evidenced by LPAs observation of R1 and R2's file. 2 out of 2 residents in care did not have reassessments completed after hospitalization's and prior to readmission back into the facility after hospital visit. This poses an immediate risk to the health, safety and or personal rights of the residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87459(a)(7)(F) · Plan of correction due date: Dec 17, 2024

87459 Functional Capabilities (a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to:(7) Physical condition, including:(F) Medical history and problems. This requirement was not met as evidenced by LPAs review of R1 file. There is no functional capabilities assessment completed addressing medical history and problems.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Administrator will provide signed documentation evidencing they understand the regulation by POC.

Type of visit: Case Management - Other

On 10/14/24, Licensing Program Analysts' (LPA) L. Salazar and M. Medina arrived to the facility unannounced to conduct a case management visit . LPAs' were greeted by staff, stated the purpose of the visit and and were allowed entry into the facility. LPAs' observed 3 residents at the time of visit. 2 of the residents were eating dinner at the table and 1 resident was being assisted by staff in their room. LPAs toured R1's bedroom and hallway bathroom. Bedroom temperature measured at 83 degrees F. Water temperature in the shower was tested and measured 109 degrees F. Exit interview conducted. Due to technical difficulties, a copy of this report will be provided via email, with a read receipt as proof of delivery. No deficiencies cited on todays visit.the state’s words, verbatim · CDSS document, Oct 16, 2024

Type of visit: Case Management - Health Checks

On 10/14/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct a Health and Safety inspection based on a death report received 10/14/24. LPA met with Administrator, stated the purpose and was allowed entry into the facility. LPA toured the facility and observed 3 residents in care at the time of visit, 2 staff and Administrator were present. LPA observed a 7-day supply of non perishables and 2 day supply of perishables. Facility inside temperature measured at 74 degrees. LPA requested Resident R1's file and obtained the following information: Admission Agreement, vendor referral form, Hospital discharge papers, staff schedule for October, Personnel report LIC 500, and facility progress notes. Administrator was unable to provide pre-admission appraisal (LIC603a), physician's report (LIC602a) or needs and service appraisal (LIC625) or reassessment/functional capabilities assessment (LIC 9172). Exit interview conducted. LPA will review documentation received and return at a later date to issue deficiencies. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, Oct 15, 2024

Type of visit: Required - 1 Year

On 06/18/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator Assistant, stated the purpose of the visit and was allowed entry into the facility. LPA observed no residents in care at the time of visit as they were all attending day program. Facility is a 4 bedroom 2 bathroom home. There is a designated office to rightof the entry. Bathrooms were observed to have grab bars by the toilets and a grab bar in the shower used by residents. Residents in care receive Regional Center services. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was 78 degrees F. LPA toured the facility inside and out and observed the facility temperature read at 75 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Facility bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 105 degrees F. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. A supply of extra linens were observed in the hall closet. Cleaning supplies were observed to be locked in a kitchen cabinet under the sink . LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Covered trash cans with lids were observed throughout the facility. Hand washing postings were observed. Carbon monoxide and smoke detectors were observed to be operational. Outside of facility was toured and observed to be clean and free from obstruction. A self-closing and self-latching gate for emergency exit was observed. First aid kits were observed to contain all required items. Medications were observed to be locked in a cabinet located in the office. Quarterly Emergency Disaster Drill logs were observed for staff. (Continued on LIC 809-C) (Continue LIC 809-C) Required postings were observed for Non-discrimination LGBTQ-A+, Personal Rights of Residents in RCFE (87468.1 and 87468.2), facility's visitation policy and LETUSNO Complaint Poster, (PUB475), Ombudsman poster and Resident Council Rights. No residents are receiving Hospice services residents or receiving Home Health care service. A sample of resident and staff files were reviewed and observed to have the required forms and training records. The following documents are requested to be updated and submitted to Fresno CCL by: 07/05/24: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Proof of Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A) An exit interview was conducted with Administrator. A copy of this report will be emailed to Administrator by next business day. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, Jun 18, 2024