Santa Teresa Care Home

Type of visit: Required - 1 Year

On 09/11/2026 at 12:50PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with caregiver, Elaine Francisco, and explained the purpose of the visit. The administrator, Back up Administrator, Henry Sevilla, arrived at 1:30pm. Fire clearance was approved for five (5) non-ambulatory and one (1) bedridden, and one (1) hospice resident. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms. One (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 80 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 103.7 degrees F. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2025. Emergency Disaster Plan was last reviewed on 08/24/2026. First aid kit was observed to be complete. Fire drill was last conducted on 07/10/2025. Continued on LIC809. Continued from LIC809C. LPA reviewed four (4) client records and two (2) of five (5) staff records. Two (2) staff did not have a record to review. LPA requested the following documents to be submitted to CCLD by 9/18/2026. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPA observed the following deficiencies: At 1:00pm, LPA observed S5 was not fingerprinted or associated to the facility. At 1:15pm, during record review LPA observed R1 and R3 did not have an updated medical assessment. At 1:38pm, LPA observed during record review R2, R5, and R6 did not have a personnel file to review. At 1:38pm, LPA observed the five (5) staff record reviewed did not have a first aid or CPR certification. At 1:45pm, LPA observed patio door from kitchen did not have a screen. Continued on LIC809C. Continued from LIC809C. At 1:50pm, LPA observed R1 had a half-bed rail, but no doctor's order. At 1:55pm, LPA observed fire extinguisher was last serviced on 8/19/2025. At 1:58pm, LPA observed during record review the last fire drill conducted was 7/10/2025. *An immediate civil penalty of $750.00 will be assessed on today's date. $250.00 is for a repeat violation for 87303(c) and $500.00 for 87355(d)* The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy appeal rights, LIC421BG, LIC421FC, and this report provided.the state’s words, verbatim · CDSS document, Sep 11, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(d) · Plan of correction due date: Sep 12, 2026

(d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement under penalty of perjury. This requirement was not met as evidence by: Based on record review S5 was not associated to the facility which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Administrator agreed to get S5 fingerprinted and submit a copy to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(h) · Plan of correction due date: Sep 22, 2026

(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having a yearly assessment for R1 and R3, which poses a health risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Administrator agreed to get a medical assessment or an aappointment and submit a copy to CCL by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Sep 18, 2026

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in have R2 and R65personnel file available for review, which poses an potential health, safety, and personal risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Administrator agreed to have a complete file for R2 and R5, and submit a self-certification that it was completed to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Sep 18, 2026

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidency by: Based on record review the Licensee did not comply with the section cited above in have all five staff first aid certified, which poses a potential health, safety, and personal risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: The administrator agreed to get all staff first aid certified and submit certification to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(c) · Plan of correction due date: Sep 18, 2026

c) All window screens shall be clean and maintained in good repair. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having a screen on the patio window from kitchen, which poses a potenetial personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: The administrator to get a screen for the patio window and submit a photo to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(a)(5) · Plan of correction due date: Sep 11, 2026

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. 5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. Based on observation the Licensee did not comply with the section cited above in having a Doctor's order for half-rail for R4, which poss a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Administrator agreed to obtain a doctor's order for half-rail and submit it to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87203 · Plan of correction due date: Sep 18, 2026

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidence by: Based on observation the licensee did not get fire extinguisher serviced, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Administrator agreed to get fire extinguisher serviced and submit invoice to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.695(c) · Plan of correction due date: Sep 18, 2026

c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in conducting a quarterly fire drill which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2026

Plan of correction: Administrator agreed to conduct a fire drill and submit documentation to CCLD by POC date.

Type of visit: Required - 1 Year

On 09/24/2025 at 4:00PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with caregiver, Elaine Francisco, and explained the purpose of the visit. The administrator, Administrator, Marivel Calambro, holds an administrator certificate #7012121740 expires 4/21/2026. Administrator arrived at 5:33pm. Fire clearance was approved for five (5) non-ambulatory and one (1) bedridden, and one (1) hospice resident. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms. One (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 79 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 101.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2025. Emergency Disaster Plan was last posted on 08/19/2025. First aid kit was observed to be complete. Fire drill was last conducted on 07/10/2025. Continued on LIC809. Continued from LIC809. Four staff records were reviewed. LPA also reviewed four (4) of five (5) resident records. One (1) resident was admitted into the facility today. LPA observed the following deficiencies: At 4:17pm, LPA observed knives, Pledge furniture polish, kitchen disinfectant, oven cleaner, and raid in unlocked cabinet underneath kitchen sink. At 4:23pm, LPA observed lock that was locked without key on door leading to garage (LPA has picture) At 4:26pm, LPA observed garage door that leads to back yard with chain lock that was locked (LPA has picture). At 4:28pm, LPA observed bedroom #2 does not have a chest of drawers, chair, and blinds are broken in window. At 4:36pm, LPA observed patio window does not have a screen. At 4:50pm, LPA observed during record reviewed the residents are missing the appraisal needs and services plans. At 5:40, LPA observed during record review staff has not completed the required 20 annual hours. Continued on LIC809C. Continued from LIC809C. LPA requested the following documents to be submitted to CCLD by 10/1/2025. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance An immediate civil penalty of $500.00 will be assessed on today's date for fire clearance (both locked doors). The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy appeal rights, LIC421M, and this report provided.the state’s words, verbatim · CDSS document, Sep 24, 2025

Type of visit: Case Management - Other

On 12/3/2024 at 3:10pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Elaine Francisco, Caregiver. Administrator, Marivel Calambro, arrived at 3:35pm, and LPA explained the reason for the visit. On 11/20/2024, LPA received an unapproved fire clearance for facility. S1 stated that she did not receive call from inspector for this facility. LPA spoke with fire inspector during visit. S1 will speak with responsible party's to move residents to different rooms or submit updated LIC200 to CCLD to resubmit to Contra Costa County fire by 12/10/2024. LPA reviewed all five (5) residents physician's report during visit. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Dec 3, 2024

Type of visit: Required - 1 Year

On 09/21/2023 at 2:30PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with caregiver, Elaine Francisco, and explained the purpose of the visit. The administrator, Marivel Calambro arrived at 2:00pm. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms. One (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 102.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/29/2024. Emergency Disaster Plan was last posted on 08/14/2024. First aid kit was observed to be complete. Fire drill was last conducted on 07/20/2024. Continued on LIC809. Continued from LIC809. Four staff records were reviewed. LPA also reviewed all four (4) resident records which were incomplete. LPA observed the following deficiencies: At 1:45pm, LPA observed during record review LPA observed all four (4) resident files were incomplete. At 1:45pm, LPA observed during record review facility did not submit a hospice initiation notification for R1. At 1:45pm, LPA observed during record review that facility did not report R1's hospitalization. At 1:45pm, LPA observed R3 had a half-rail but facility does not have a doctor's order. At 2:15pm, LPA observed during record review S2 does not have a health screening. At 2:45pm, LPA observed facility have two (2) bedridden residents located in bedrooms 2 and 3. At 4:30pm, LPA observed during record review facility did not maintain a record of each dose in the resident's record. LPA requested the following documents to be submitted to CCLD by 9/18/2024. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Continued on LIC809C. Continued from LIC809C. *An immediate civil penalty of $750.00 will be assessed on today's day* 87202(a)(2) = $500.00 1x 87608(a)(3) = $250.00 for repeat The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy appeal rights and this report provided.the state’s words, verbatim · CDSS document, Sep 11, 2024

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.