Rodelou Care Home

Type of visit: Required - 1 Year

At approximately 10:30AM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and met with Administrator Delia Ulbata. Facility is a Residential Care Facility for the Elderly (RCFE) with ten (10) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:40AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. LPA was informed that the second story is solely for live in-staff and is only accessible from a locked outside door. Facility's fire extinguisher was observed charged and LPA was informed it was newly purchased. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 111.3 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) unlocked shed in the backyard which LPA inspected and observed to contain old mobility devices Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 2/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Facility has an internet access device and internet available to residents in care, and the phone was tested and operational during today's inspection. At approximately 11:30 AM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 12:05 PM LPA conducted review of four (4) staff records. Two (2) of four (4) staff did not have medical assessments or TB testing on file, four (4) of four (4) staff did not have personnel records or resume on file, and four (4) of four (4) staff did not have current training (deficiencies cited). At approximately 12:15 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Delia Ulbata Administrator Certificate 7010438740 expires 06/23/2027. LPA gathered updated LIC308 - Designation of facility responsibility and LIC500 - personnel report. Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: Liability Insurance LIC610E - Emergency Disaster Plan Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, May 15, 2026

Type of visit: Required - 1 Year

At approximately 10:40 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Administrator Delia Ulbata. Facility is a Residential Care Facility for the Elderly (RCFE) with ten (10) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with one(1) Hospice residents currently in care and is approved for all non-ambulatory residents. At approximately 11:40 AM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a one (1) story home, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 2/25. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Water temperature measured 113.3 degrees F and 115.5 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food. There is a shaded seating area in the backyard with outdoor space for activities. Facility has an internet access device designated for resident use and internet service available. Facility telephone was tested and operational during inspection. LPA observed that that one (1) of two (2) backyard gates was in need of repair with boards of wood falling off when LPA attempted to open it (deficiency cited). Continued 809C... Continued from 809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 2/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 3/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 12:45 PM LPA conducted a review of five (5) resident records. All required documentation present. At approximately 1:30 PM LPA conducted review of two (2) staff records. All required documentation present. At approximately 2:00 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Delia Ubata Administrator Certificate 6035695740 expires 6/23/2025. All fees are current as of this time. Updated copies of the following documents were gathered during this visit: Liability Insurance LIC500 - Personnel Report LIC610E - Emergency Disaster Plan Updated copies of the following documents shall be submitted to CCL within 30 days of this visit: LIC400 - Affidavit Regarding Client Cash Resources LIC308 - Designation of Responsibility Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. Exit interview conducted with Administrator, whose signature on form confirms receipt.the state’s words, verbatim · CDSS document, May 12, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 11:30 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by Delia Ulbata, Licensee/Administrator. The facility is a single story home licensed for ten (10) non-ambulatory residents and a hospice waiver capacity of two (2). The facility currently provides care for 8 residents and there is one resident under hospice care at this time. At approximately 11:45 AM, LPA and Administrator toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected ,There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and kitchen. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 109 and 113 degrees F at three of three faucets accessible to residents. One out of one fire extinguisher was inspected and charged. Thirteen out of thirteen Smoke Detectors and two out of two Carbon monoxide detector were present inspected. There was enough lighting in all common areas, resident rooms, and hallways. Medications located in designated cabinet were found to be secured. LPA conducted a spot check of medications and found all administering and records to be in order. Continued on LIC809-Ca Continued from LIC809 At approximately 12:25PM, LPA reviewed Eight out of Eight resident records which were all found to be well organized but missing the required documentation(Updated LIC602, Signed LIC613, LIC601). At approximately 1:00 PM, LPA reviewed two out of two staff records which did not include Administrator's staff file but not on site. LPA advised Administrator all required documentation must be kept at the facility and accessible to CCLD/LPA. LPA advised citation was given on 07/23/23 for missing training files Civil Penalties assessed for repeat violation. Medication records are thorough and contained physician's orders for each resident. Administrator Administrator Certification is current and expires on 06/23/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 500 Personnel Summary LIC 9020 Register of Facility Client’s/Resident's LIC610- Disaster Plan (updated with non-local evacuation site) Staff Training Records including First Aid for all staff Updated LIC602 for all residents Signed LIC613 for all residents LIC601 for all residents Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in additional civil penalty assessment. This report was reviewed with Delia Ulbata and Appeal rights were given.the state’s words, verbatim · CDSS document, Jun 26, 2024

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.