Sta. Rita's Elder Care

Type of visit: Required - 1 Year

On September 24, 2026, at 12:30 PM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Staff 1 (S1) Evangeline Ujano and explained the purpose of today's visit. The Administrator 1 (A1) Rita Flowers arrived shortly after. The facility is licensed for five (5) non-ambulatory residents. There are currently four (4) residents who reside at this facility. The facility has an approved hospice waiver for three (3). One (1) out of the three (3) hospice placements are occupied. At 12:45 PM, LPA conducted record reviews of 4 staff and 4 resident files. Staff files were observed to contain Health Screening, First Aid Certificates, Background Clearance, and updated training records. Resident files contained Health Screening, TB Test Records, and current Needs and Services Plans. At 1:15PM, LPA conducted a medication review. Medications were stored in a locked cabinet. The facility uses a MAR sheet to record all dispensed medication to residents. At 1:40PM, LPA toured the facility with A1. The facility kitchen was observed to be clean and free of hazards. The facility stores sharps and toxins in locked cabinets and drawers in the kitchen. The facility contained at least 2 days of perishable food items and at least 7 days of non- perishables. The kitchen appliances were observed to be operational. LPA toured the dining room and living room areas which were observed to be clean and free of odors. Enough seating was present to accommodate the current census. Continued on LIC 809-C. The LPA toured the resident bedrooms. The bedrooms were clean and free of hazards. The rooms were furnished with beds, night stands, and dressers which were in good repair. The facility restrooms were clean and sanitary. The showers contained grab bars and slip-resistant mats for resident safety. The restrooms also contained hand washing supplies. The LPA conducted a visual inspection of the staff room from the entrance. The LPA toured the laundry room which contained detergent in locked cabinets. The facility utilizes the garage as a storage room and office area. LPA toured the exterior of the facility. The exterior walkways were free of obstructions. The side exit and perimeter fence were in good repair. The facility temperature was 75 degrees. The facility's hot water temperature was 111 degrees. The facility's fire extinguishers were serviced annually on August 13, 2026. The LPA requested the following documents to be emailed/ faxed to the Regional Office within 15 days: - LIC 500 Personnel Report, LIC 308 Designation of Facility Representative, LIC 610E Emergency and Disaster Plan, and a copy of the Liability Insurance Certificate. As a result of this annual inspection, the facility was in compliance and no deficiencies were cited. An exit interview was conducted and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 24, 2026

Allegation investigated: Staff did not refill residents medications timely resulting in missed medications Staff did not provided authorized representative complete resident record upon discharge

On August 27, 2026, at 9:30 AM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct a complaint investigation on the above allegation(s). LPA Lopez met with Administrator Evangeline Ujano and explained the purpose of the visit. The current census is (4) residents. Throughout the course of the investigation, LPA Lopez conducted interviews, record reviews, and a facility inspection. Medication administration records were reviewed and observed to be complete and properly maintained. During the visit, it was learned that the resident on the complaint report did not reside at this facility. As a result of the investigation, the Department finds this allegation to be Unfounded. A finding that the complaint is unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis. Per California Code of Regulations (CCR) - Title 22, no deficiencies were cited during this visit. An exit interview was conducted with, and a copy of this report was provided to the facility. Unfoundedthe state’s words, verbatim · CDSS document, Sep 1, 2026 · control 27-AS-20260824121152

Allegation investigated: (13) Medication (8) Record Keeping

This LIC 9099 report has been amended to reflect the above allegations. A new LIC 9099 will be created, which will supersede this report. On August 27, 2026, at 9:30 AM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct a complaint investigation on the above allegation(s). LPA Lopez met with Administrator Evangeline Ujano and explained the purpose of the visit. The current census is (4) residents. Throughout the course of the investigation, LPA Lopez conducted interviews, record reviews, and a facility inspection. Medication administration records were reviewed and observed to be complete and properly maintained. During the visit, it was learned that the resident on the complaint report did not reside at this facility. As a result of the investigation, the Department finds this allegation to be Unfounded. A finding that the complaint is unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis. Per California Code of Regulations (CCR) - Title 22, no deficiencies were cited during this visit. An exit interview was conducted with, and a copy of this report was provided to the facility. Unfoundedthe state’s words, verbatim · CDSS document, Aug 27, 2026 · control 27-AS-20260824121152

Type of visit: Required - 1 Year

On 9/18/2025, Licensing Program Analyst (LPA) Cynthia Tamayo arrived unannounced to conduct a required - 1 Year visit. LPA met with Administrator Rita Flowers (S1) and explained the purpose of the visit. Administrator certification expires on 8/30/26. The facility is licensed to serve up to 5 non-ambulatory residents. Hospice approved for 3. Current census is 4. LPA toured the facility with Administrator S1 and staff 2 (S2). LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 115.3.*F which was within the required range of 105-120*F. The temperature inside the facility measured at 70*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. LPA requested resident and staff files for review. LPA reviewed (2) staff files and (3) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. Continued on 809-C The following forms were collected and will be added to facility file: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance, LIC 308, LIC 9020. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Required - 1 Year

On 9/6/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a required - 1 Year visit. LPA met with Administrator Rita Flowers and explained the purpose of the visit. Administrator certification expires on 8/30/2024. Renewal application is pending. The facility is licensed to serve up to 5 non-ambulatory residents. Hospice approved for 3. Current census is 5. LPA toured the facility with Administrator Rita Flowers. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 107.8*F which was within the required range of 105-120*F. The temperature inside the facility measured at 73*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. LPA requested resident and staff files for review. LPA reviewed (2) staff files and (3) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following forms and documents were requested to be submitted within 15 days: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed. An exit interview was conducted, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Sep 6, 2024