Star Dust Home

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for six non-ambulatory residents. Facility has an approved hospice waiver for four residents and the home currently has two residents who are on hospice. Administrator (AD) Fatima Rivera assisted LPA conduct facility tour. AD provided updated liability insurance that expires on 07/01/2026. LPA along with AD toured the facility at 1:30 PM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of four resident bedrooms, two staff rooms, living room, dining room, and kitchen, four bathrooms and an attached garage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.3 degrees F and 114.2 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a drawer during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 01/06/2026. Outside grounds were toured. Walkways around the home were clear of hazards. There is outdoor seating for residents. Exit gate is unlocked and operational. LPA observed the emergency food and water supply. First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed two resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

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

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPAs were greeted and granted entry by facility caregiving staff and facility administrator Fatima Rivera after introducing themselves and stating the purpose of the visit. There are currently four residents in care, two of which are receiving hospice care. LPAs observed residents relaxing in their respective bedrooms and in the facility's common living areas. LPAs accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has four bedrooms, currently privately occupied. There are three bathrooms throughout the facility, two of which are for use by residents. Two additional rooms on the other side of the house are for use by staff members only and inaccessible to residents. Bedrooms appeared clean and sanitary. Full bed rails are present in two bedrooms. Residents confirmed to be receiving hospice care and plans of care reviewed to include physician orders for the postural supports. LPAs observed all the resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Bathrooms are equipped with grab bars and slip mats. Hot water temperature measured at 107.7F and 109F. LPAs observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items are stored in a secure drawer. Fire extinguishers are charged and mounted, with up-to-date maintenance documented on the attached tags. LPAs tested the smoke and carbon monoxide detectors which were found to be operational. The centrally stored medication is located in a locked metal cabinet closet in the dining area. The attached garage is inaccessible to residents and is used for storage and laundry. Cleaning supplies are stored securely in the passageway to the garage. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPAs and facility staff toured the outside of the facility. LPAs observed an shaded outdoor seating areas with furniture for resident use. The perimeter gate on one side of the property is self-latching. LPAs reviewed four resident records which included all necessary components. One physician report for a resident diagnosed with dementia is dated by over a year. Consultation provided. LPAs reviewed resident medication records and prescription orders for all four residents, no discrepancies observed. One resident is assessed to be bedridden per their physician report, which was later confirmed in an interview with the resident's hospice nurse. The facility's current fire clearance does not include a provision for any bedridden residents at this time. Citation issued. LPAs reviewed three staff records which were found to be complete. Training and CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Based on the observations made during today’s visit, one type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. Consultations provided on attached Advisory Notes form. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Jan 3, 2025

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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Administrator (AD) Fatima Rivera. For today’s visit, LPA observed a total of 4 residents in care and 2 staff members on duty. LPA observed the Administrator's Certificate for facility AD Fatima Rivera which expires on 10/06/2024. LPA Ramirez toured the interior and exterior portions of the facility with AD Rivera. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 4 may be on hospice and 0 bedridden. For this visit, there are a total of 4 residents in care. There are a total of 6 bedrooms, of which 4 are private resident bedrooms, and 2 private bedroom for staff. LPA Ramirez toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 4 restrooms of which 2 are for staff and 2 are for residents. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 109.5-110.8 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located by the laundry room. LPA Ramirez observed the emergency disaster and evacuation plan, which is posted by the kitchen hallway. Facility had back-up emergency food and water supply, located in the garage CONTINUED ON LIC809-C... LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA Ramirez observed a shaded area with furniture, and the grounds were free of any hazards. There is 1 gate in the backyard, which is self-closing and self-latching. No bodies of water were observed. LPA reviewed four resident files and two staff files. LPA interviewed residents and staff present. For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD Rivera. A copy of this report was provided at the time of exit.the state’s words, verbatim · CDSS document, Apr 19, 2024