St. Therese Elderly Care Facility

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced inspection visit for case management - deficiencies. LPA was greeted by 2 staff. Administrator Michelle Benitez was not at the facility at the time of arrival. ADM Michelle Benitez arrived at the facility at 4:58 p.m. LPA stated the purpose of the visit. The visit is to clear the deficiency that was cited on 12/18/2025 based on California Code of Regulation (CCR) Title 22: LPA toured the facility inside and outside. 87303 (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). During today's visit LPA measured the water temperature with the digital thermometer in the kitchen and bathroom and measured at 111.3 to 112.8 degree F which complies with CCR Title 22. 87309 (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. LPA observed the knives and chemicals were locked and not accessible to residents in care. page 1 of 2 see LIC 809C 87309(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. LPA observed that gardening supplies and potting soil is removed, stored properly and no longer pose a hazard to residents in care. ADM is completing Type B violations and is due on 01/02/2026. No deficiencies were cited during today's visit based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted with Administrator Michelle Benitez. A copy of the report an POC letter was provided. end of report Page 2 of 2the state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced Required 1-Year inspection visit. LPA met with the Administrator, Michelle Benitez and stated purpose the visit. The facility is licensed to serve adults 60 and over, 6 ambulatory and 6 out of 6 may be non-ambulatory and a hospice waiver for 5. The facility has a current census of 5. At the time of the visit (0800), one staff and administrator was busy assisting resident with their activities of daily living (ADLs). LPA was accompanied by the administrator during inspection of the facility inside and outside. LPA observed exterior walkways were free from any obstruction ramps and railings. The back ramp was observed to have some signs of wear and tear. A gazebo was observed and items were stored in the gazebo, such as tables, propane gas tanks, cat scratchers, some chemicals on the table, cat food on the table, some gardening tools to name a few. LPA observed a sack of plant food/fertilizer. ADM stated the gazebo is not used by residents during winter season. In the summer time, the gazebo is cleaned and de-cluttered for resident's use. LPA inspected the garage and laundry area, found the laundry area unlocked. Laundry detergents were observed on top of the shelves above the washer and dryer. Washer and dryer were in good working condition. The garage was organized and has a walkway that was not obstructed. LPA inspected the interior of the facility and observed that hallways were free from obstruction and free from tripping hazard. The hallways were well lighted. 5 out of 5 resident bedrooms are sanitary and organized, furnished with dressers, chairs and tables that are sufficient to store resident's personal belongings. LPA observed that 5 Out of 5 residents are non-ambulatory, at the time of the visit 2 Out of 5 residents were awake and 3 Out of 5 were in bed resting. page 1 of 3 - continued to LIC 809 C LPA inspected 2 resident bathroom and found it clean, sanitary, with hygiene supplies. Bathroom were equipped with grab bars, non-slip floor, a shower chair, and a raised bathroom seat. The hot water was measured with a digital thermometer. Water temperature for both bathrooms measured at 137.6 to 139 degree F. LPA inspected the dining area and living area and observed gifts bags the floor at the corner end of the table was piles of papers, set aside to make room for Christmas decorations. The living area has gift bags and items to be wrapped for the holiday season. The couch has gift items, and gift wrappers on top. ADM stated that they are in the process of wrapping gifts for the coming holiday to be distributed. LPA inspected the kitchen, and observed that the kitchen was sanitary. The kitchen counter has food items such as bread, tray of 30 eggs sealed, cookies, a box of corn dog, food on top of the stove covered with glass lids, a container of meat on top of the corn dog box. A container of take out food that was eaten and left on the counter top, fresh produce on the corner left side of the kitchen counter and a crate of fresh produce on the kitchen floor (photos taken). A LPA observed an upright refrigerator/freezer combination, with 2 days of perishable items. The refrigerator temperature measured at 38 degree F and the freezer measured at 0 degree F. Water temperature measured at 133 degree F with a digital thermometer. LPA observed a drawer with the key containing the sharps and knives that was unlocked and no staff was present. LPA observed 7 days of non-perishable items. The facility is equipped with a working smoke and carbon monoxide alarm a fire extinguisher (last inspected 09/30/2025). First aid kit with the guidebook. Emergency disaster training, fire and earthquake drill was administered on January 2025 and no subsequent drills and training were administered. LPA reviewed 5 out of 5 resident file record and observed the following, 3 out of 5 are missing the consent form, 2 out of 5 has incomplete or missing client's personal valuables (LIC 621), 1 out of 5 is missing proof of TB testing, 2 out 5 does not have the appraisal needs and services plan, 5 out of 5 does not have the weight record. 5 Out of 5 resident record has complete and updated Centrally Stored Medication & Destruction Record (CSMDR). LPA reviewed 3 out of 3 staff record and observed the following; 3 Out of 3 Staff are missing the SOC341A (mandated reporter) 1 out of 3 is missing the LIC 503 (health screening), 1 out of 3 training was last administered on 07/07/2024, 1 out of 3 is missing the LIC (501) personnel record/job application. page 2 of 3 - continued to LIC 809C Based on observation and record review following were observed that may pose an immediate or potential risks to persons in care. The water temperature measured from 133.1 to 139.7, food safety and storage the laundry area was unlocked, laundry detergents were observed. At exterior area; gazebo contains chemicals on top of the table, gardening tools and potting soil. The ramp by the back side is showing signs of deterioration. LPA observed unlocked drawer containing knives and sharps and no staff was present in the kitchen. LPA suggested to LIC/ADM to reach out to the department's Technical Support Program (TSP). The TSPs are non-enforcement programs of CCLD and provide services, training, and resources to support providers in meeting licensing requirements. Deficiencies are cited during today' visit based on California Code of Regulation (CCR) Title 22, other deficiencies were issued technical violations based on what was observed and the severity of the deficiency. (See LIC 809D). An exit interview was conducted with licensee/administrator Michelle Benitez. A copy of the report and appeals rights were provided end of report page 3 of 3the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Required - 1 Year

On December 16, 2024, at 11:45 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Administrator, Michelle Benitez and disclosed the purpose of the inspection. The administrator informed the LPA that the facility currently has 3 residents in care, and (2) of them are non-ambulatory. At 11:55 AM, the LPA initiated a walk-through of the facility, accompanied by the administrator. The LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. LPA checked the appliances and observed them in working order. The locked cabinet containing knives and the locked cabinet under the sink with soap and cleaning supplies were also inspected. LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. No expired food and no stored medications were noticed. The LPA inspected the dining area and observed it clean, with all the furniture in good repair. There was a dining table and enough chairs to accommodate all the residents. The LPA inspected the fire extinguisher mounted on the wall between kitchen and living room and found it was fully charged with a last service tag of 10/02/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. There are (5) bedrooms and (2) bathroom designated for residents' use and (1) bedroom designated for staff. (4) resident bedrooms are private and (1) bedroom is shared occupancy. LPA inspected all (5) resident rooms and found them clean, well-lit, and equipped with the required furniture. At 12:06 PM, LPA inspected the common resident bathroom and found it clean, sanitary, and in good working condition. It contained soap, grab bars, a trash can, non-slip flooring, a shower chair, and a raised bathroom seat. The hot water temperature at the sink faucet was measured at 144.5°F. Continued on LIC 809-C The LPA inspected the storage space in the hallway and observed it containing clean linens for residents’ use and found it well organized. The LPA toured the backyard area. The backyard has a gazebo with a set of a patio table and chairs for the resident’s use. There were no bodies of water noted. The ramps and decks were found clear of obstructions and tripping hazards. At 12:22 PM, LPA inspected the garage and observed a freezer. The garage was observed cluttered with boxes, Incontinence supplies, furniture, food supplies, and mattresses. LPA inspected the laundry room and observed a washer and dryer. At 12:34 PM, The LPA reviewed (2) staff personnel records and (3) resident records. The LPA observed that 3 of 3 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA reviewed that 2 of 2 staff members didn’t have current first aid certificate. LPA reviewed that 1 of 2 staff members is not associated with the facility. The LPA observed a locked centrally stored medication cabinet located next to the dining area. Medications were organized in separate bins for each resident. All medication bottles were properly labeled. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete. The LPA inspected the first aid kit and observed it fully stocked. At 12:58 PM, the LPA was not able to review Emergency Drill Logs as the Administrator was not conducting emergency Disaster Drills quarterly. The following updated forms are requested to be submitted to CCLD by 12/23/2024: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and left with the Administrator, Michelle Benitez, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Dec 16, 2024