Queen of the Angels Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Joel Basillo and Cathlyn Eroza, Caregivers and explained the purpose of the visit. The administrator, Terry McGenn was called to inform of the visit. At 10:25am, Barbara Boiston, House Manager arrived and assisted LPA. The facility is approved to serve residents age range 60 and above. Facility fire cleared for (2) ambulatory and (4) non ambulatory residents age 60 and above. Approved to accept or retain up to (6) residents on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs prior to being around residents. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: Facility has working signal systems in exit points. The facility has a dementia care plan to accept or retain residents with dementia. Staff have the required training to provide special care to dementia residents. Staff cannot provide a copy of the liability insurance during the visit. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (6) bedrooms, one of which is a staff bedroom, (3) bathrooms, living room with fireplace, family room with a fireplace, kitchen, dining room, laundry area and backyard with patio area. There are currently (5) residents, 60 years and older residing in the facility, (1) is under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed the large sliding door in the staff bedroom is impassable, completely blocked by stacks of boxes. LPA observed that the living room is used for sleeping which was confirmed by a staff member. The fireplaces are adequately screened and inaccessible to residents. Backyard was inspected and has a swimming pool surrounded by a locked gate. There are (2) fire extinguishers in the facility which were serviced on 04/15/2026. Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. Knives, cleaning solutions, and disinfectants are locked. Smoke alarms and carbon monoxide were tested and operable. Hot water temperature reading measured within the required 105 - 120 degrees Fahrenheit *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (8) caregivers including the Administrator provide care and supervision to the residents. One (1) staff provides night supervision and can assist in caring for residents in the event of an emergency. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required Administrator courses and certificate is valid through 04/08/2027. Resident Rights-Information: Resident personal rights are posted. Facility provides internet services to all residents and have access to the facility phone. Facility provides initial and ongoing training for staff. Planned Activities: The facility provides sufficient space to accommodate both indoor and outdoor activities. Residents are encouraged to participate in a variety of planned activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. LPA observed uncovered left over food in the refrigerator and food containers were not labeled. LPA also observed the preparation plastic bowls were stored along with cleaning supplies and other chemicals in a kitchen cabinet under the sink. Incidental Medical Services: Residents' medications were reviewed during the visit. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are stored in a locked cabinet and inaccessible to residents. Facility did not have an up to date prescribed and PRN medication list for the residents. Staff did not properly document the medications administered to the resident on the medication administration record (MAR). Resident Records-Incident Reports: Five (5) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Fire drill conducted monthly, last fire drill was on 04/02/2026. Residents with SHN: (1) resident is under hospice care and one resident on oxygen. Physician orders for 1/2 bed rails were reviewed on the residents' files. Staff did not have training in the operation of the oxygen equipment. Deficiencies cited and Technical advisories issued. Exit interview and a copy of this report along with the appeal rights were provided to Barbara Boiston, House Manager.the state’s words, verbatim · CDSS document, May 15, 2026

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Cynthia Chan and Elena Mallett conducted the required annual inspection. LPAs met with the House Manager, Barbara Boiston, and the purpose of the visit was explained. The fire clearance has been approved for a capacity of 6 residents, of which (4) may be non-ambulatory. The hospice waiver is approved for 1 resident. LPAs inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. Facility is continuing to follow their Infection Control plan. The facility has a dementia care plan to accept or retain residents with dementia. There are currently 6 residents residing at the facility. The facility is a single story home with 6 bedrooms (5 for residents and 1 staff bedroom), 3 bathrooms, living room, dining room, family room, kitchen. The facility has a swimming pool in the backyard and is surrounded by a locked gate. Bathrooms have non-skid mats in the shower area and grab bars. Knives, cleaning solutions, and disinfectants are locked. The hot water temperature was measured between the required range of 105-120 degrees F. The backyard has tables and chairs for residents to use. The facility has auditory devices at the exit doors. Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. The kitchen is kept clean and sanitary. The facility has sufficient space to accommodate indoor and outdoor activities. LPA reviewed 3 staff files and the CPR & First aid certificates are current. LPA reviewed 6 resident files and the following documents are found - admission agreements, Identification & Emergency Information, Physician's Report, Consent forms, Resident rights, Safeguards for Personal Property Valuables form. There are 3 residents receiving hospice services and one resident on oxygen. Medications are centrally stored and locked. Resident medications are being given as prescribed. The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Emergency Disaster Plan is updated and reviewed annually. A deficiency is issued on the LIC809D form. An exit interview was held and a copy of this report was given to Barbara Boiston.the state’s words, verbatim · CDSS document, May 30, 2025

The state marks this report as 4 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

Licensing Program Analysts (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with caregiver Joel Basilio assisted with the visit. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. The fire clearance is licensed to serve elderly residents age 60 and above. The fire clearance approved for two (2) ambulatory and four (4) non-ambulatory residents age 60 and above. Approved to accept or retain resident one (1) on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: The facility does not have an infection control plan in place but they continue to practice hand washing and disinfect in the facility. Facility has sufficient PPE supplies. All staff does not have any health screening and TB test result in their personnel file. 2. Operational Requirement: he facility has a dementia care plan to accept or retain residents with dementia. Currently there's one resident is on hospice and no resident is bedridden which is under the fire clearance requirement. The liability insurance was not able to review during the annual inspection. 3. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area, the facility includes: living room, family room, dining room, kitchen, live in staff room, five residents bedrooms, three bathrooms and a detached garage. Bedroom#1 has two beds, two drawers, required beddings and furniture and sufficient lighting and closet space. Bedroom#2 to #5 has one bed, one chair, one drawer, required beddings and sufficient lighting and closet space. All the bathrooms have the required grab bar and non-skid mat. The hot water temperature tested in Bathroom#2 and bathroom were 116.4 and 118.4 which are within the Tittle 22 regulation. The hot water in Bathroom#1 is not operating. All the chemicals are stored and locked under the kitchen sink. All the appliances in the kitchen are working properly. The facility has a telephone on the premises. 4. Staffing: Facility has sufficient staffing to provide care and supervision to residents. The facility has at least one person to have CPR and First Aid Training on duty. All the staff are over 18 years old. 5. Personnel Record-Training: All staff files are locked in a locked box under the staff desk. All the staff are fingerprint cleared and associated with the facility. The administrator file was not in the facility and LPA was not able to review administrator qualification. 6. Resident's Right-Information: The facility has all the posted include resident's personal right and complaint poster..etc and its located on the wall near the entrance. The facility also has internet service device for residents to use. 7. Planned Activity: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 8. Food Service: The facility has two days perishable and seven days non perishable food supply. All the food are stored properly in the facility. No resident in the facility required any modified diet that prescribed by the doctor. 9. Internal Medical and Dental: The resident family usually arrange resident's medical and dental appointments. All the resident's medication are centrally stored and LPA inspected all six residents medication and they all seemed accurate and up-to-dated. All the residents have the 30 days supply of medication. 10. Resident Record-Incident Report: All the client's files are stored at the Medication Cabinet near the entry way. LPA inspected all six residents files. All resident files have the face sheet, pre-appraisal and resident's appraisal in file but LPA observed R1, R2, R3 and R4 do not have the updated needs and service plan/appraisal. R2 does not have the updated physician report and the last one was dated back in 2018, R3 does not have any physician report prior the admission. R3 also does not have the signed admission agreement in file. 11. Disaster Preparedness: The facility does not have an updated Emergency Disaster Plan and last one was updated back in 2010. The facility does not have any documentation for fire/disaster drill. The facility does have two alternative shelter location. 12. Residents with Special Health Needs: Currently the facility has two residents are on home health and one resident is on hospice. All the home health information and hospice record are along in resident's files. The facility has a swimming pool in the backyard and it's fenced and compliance with the state and local building codes. All the sharp knives and utensils are stored and locked in the kitchen drawers. The dementia resident does not have an updated Needs and Service plan in file. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy of the report was given to the caregiver Joel Basiliothe state’s words, verbatim · CDSS document, May 23, 2024