Starlight Care Home

Allegation investigated: Staff left resident in soiled clothing for an extended period of time. Staff are not properly utilizing incontinence supplies.

* The facility closed on 7/14/2026. Licensing Program Analyst (LPA) Galarza called Licensee/Administrator multiple times to deliver finding telephonically on the above allegations. Licensee Ana Duenas did not respond. This report will be mailed and emailed to the licensee’s last known mailing address. The investigation consisted of the following: On 6/19/2026 a physical plant tour of the facility was conducted. R1's file was reviewed. However, the resident's file was incomplete and copies were not obtained because the facility did not have a copy machine or printer in the premises. Therefore, none of R1's documents were obtained. Administrator emailed some records at a later date, but not all records were submitted. Staff (S1 &S2) and residents (R2 &R3) were interviewed. Residents (R1, R4 & R5) were not interviewed due to cognitive impairment. LPA obtained hospice information. ***Narrative summary continues next page. Substantiated Allegation: Staff left resident in soiled clothing for an extended period of time. The complaint alleges that resident (R1) was being neglected because 3rd party agency personnel frequently found the resident soiled when they arrived to provide services to the resident. LPA reviewed records and interviewed hospice personnel, facility staff, and two residents. Residents stated they are changed 3 to 4 times a day. The facility has a total of two live-in staff whom stated R1 received incontinence brief changes at 4:30 AM, 1:00 PM, and 4:30 PM, and occasionally the resident had their brief changed at 6 PM. Both staff live in the home, and the primary caretaker's shift ends at 8PM. Therefore, the resident was not changed until the following day at 4:30 AM. Staff stated that Administrator never provided incontinence care or pressure injury training, but learned through past hospice nurses that provided care for residents. Administrator was not cooperative with interview questions. According to hospice personnel R1 had been receiving daily visits since June 1, 2026 for stage 2 pressure injury to the coccyx and deep tissue injury to right hip. After admission to hospice R1 developed left heel blister, redness to right heel, and stage 2 at right hip developed from the deep tissue injury originally noted at admission. Observations made by hospice personnel revealed that facility staff were not attending to R1's soiled brief, and despite attempted care education of caregivers they continued to show deficits in care and suspected neglect was communicated to licensee/Administrator, but Ms. Duenas was non-responsive regarding standards of care. The resident died on June 27, 2026. The allegation is supported. Allegation: Staff are not properly utilizing incontinence supplies. It is alleged caregivers use incontinence supplies inappropriately in a way that promotes or encourages infection or caused concern for resident safety. Two residents were interviewed. One resident stated they heard that R1 did not have enough incontinence supplies. The facility has two live-in staff. Staff interviews revealed that hospice agency supplies resident (R1) 2 bags of incontinence briefs per week, each bag has 15 briefs. Staff stated R1 did not have enough incontinence wipes, briefs, and spray. Caregivers stated Administrator called R1's family requesting supply of briefs, and also called the pharmacy. During the visits, incontinence supplies were checked. Resident (R1's) supply was limited. The findings indicate the Licensee/Administrator never purchased extra supplies for resident (R1). The allegation is supported. Based on observation and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6. See LIC 9099D. Exit interview was conducted with Administrator Ana Duenas. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 6, 2026 · control 28-AS-20260617120041

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(7) · Plan of correction due date: Aug 6, 2026

Managed Incontinence. Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring. This requirement was not met evidenced by: Based on interviews, live-in caregivers only provided incontinence care 3-4 times of cognitively impaired, bed bound resident (R1), which caused deep tissue injury stage advancement. This posed an immediate health, safety, and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: *Facility closed on 7/22/2026. Licensee/Administrator was not responsive and has not responded to the Department. No POC is required. The facility is closed and R1 passed away on 6/27/2026.

From the deficiency page — Deficiency type: Type B · Section cited: ILS 87705(b)(1)(A) · Plan of correction due date: Aug 6, 2026

Care of Persons with Dementia. Licensees shall be responsible for the following: Ensuring staff receive the following training as part of the training requirements.....Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; This requirement was not met evidenced by: Based on interviews, the findings indicate caregiver staff used incontinence supplies inappropriately that promoted and encouraged infection; which posed a health, safety, and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: *Facility closed on 7/22/2026. Licensee/Administrator was not responsive and has not responded to the Department. No POC is required. The facility is closed and R1 passed away on 6/27/2026.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff Antonio Santiago. Facility Designee Andrew Escobar arrived shortly after. Administrator has a valid administrator's certificate expiring on 7/26/2027. The following was observed during the inspection: Infection Control: The facility has an Infection Control Plan. Operational Requirements: A Dementia and hospice waiver for 3 residents has been approved. A fire clearance for 5 non-ambulatory and 1 bedridden in room #3. The facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 9/11/2026. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single-story home located in a residential area consisting of three (3) shared resident bedrooms, one (1) live-in staff room, two (2) bathrooms, kitchen, dining room, living room,and laundry area in attached 2-car garage currently used as storage. The backyard has an covered patio and storage shed in the rear of the backyard. The front and backyards are landscaped with grass. Required furniture, bed mattress pads, and linens were observed. Cleaning supplies and toxic substances are inaccessible to residents. The facility has two fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Electrical smoke and carbon monoxide detectors were tested and are operational. The home has central heating & air conditioning. Comfortable temperature for residents is maintained. Exit doors are free of any obstruction and there are no pools. No record of Emergency Disaster drill was provided. A citation was issued. Staffing: A total of 2 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Staff have criminal background clearance and training. Three (3) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training is current. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Orders, and medical consent. All resident files are missing Appraisal Needs and Service Plans and R1's medical assessment is blank, R2's is dated 9/13/2023, R3's is dated 7/12/2024, R4's is dated 10/21/2024, R5's is dated 10/8/2025 but is incomplete. Citations were issued. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Residents have modified diets. Incident Medical and Dental: Three (3) centrally stored / 30-Day supply of medications were reviewed. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. The facility has a First Aid Kit and Manual consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Residents with Special Health Needs: Two (2) residents receives hospice services and three (3) residents receive home health services. One resident is bedridden in room 3. Pursuant to California Code of Regulations, Title 22, deficiencies were cited. An exit interview was conducted with Facility Designee Andrew Escobar. A copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Jun 12, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Galarza conducted an unannounced case management visit. LPA met with Licensee/ Administrator Ana Duenas. Office Manager Andrew Escobar arrived shortly after. The purpose of the visit was to follow-up on items addressed during the Noncompliance Conference (NCC) meeting held on September 17, 2025. During the NCC meeting licensee agreed to: Hire an additional staff member within 30 days of (9/17/25) that will work as needed for oversight of record documentation, and other facility responsibilities. Status: On 11/3/2025, Licensee Ana Duenas hired Office Manager Andrew Escobar. Licensee continues to be the facility Administrator. Ms. Duenas stated she cannot financially hire an Administrator. Licensee agreed to submit a written plan, update the Plan of Operation and facility sketch addressing live-in staff accommodations. If a permit for an additional dwelling unit (ADU) has been requested submit proof of documentation. Status: Licensee stated that the 2 live-in staff, of which one was sleeping in the garage and the other in the living room are now sleeping in former resident room #3. The room was designated as a live-in staff room. The facility sketch was updated. * Pending: An updated Plan of Operation that addresses physical plant changes has not been submitted. A repeat citation and civil penalty was assessed. Visit observations: 1. (R1) is not currently enrolled in hospice and their bed had full bed rails, 2. A Vitamin B-12 1,000 mcg was observed unlocked in the living room and Allergy Relief Antihistamine 10 mg was observed unlocked in staff room. Pursuant to Title 22, citations were issued. Exit interview was conducted and a copy of the report/appeal rights were issued to Ana Duenas.the state’s words, verbatim · CDSS document, Mar 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Mar 27, 2026

Postural Supports. Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement was not met evidenced by: Based on observation, the licensee did not comply with the section cited above in that (R1) is not enrolled in hospice and their bed had full bed rails, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Staff agreed to remove the full bed rails. Please submit a copy of the half bed rails physician's order and a picture R1's bed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Mar 27, 2026

Incidental Medical and Dental Care. The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met evidenced by: Based on observation, a Vitamin B-12 1,000 mcg was observed unlocked in the living room and Allergy Relief Antihistamine 10 mg was observed unlocked in staff room. This poses an immediate health, , safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Administrator shall submit proof that staff were trained in regulation 87465 and medication storage facility procedures.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Apr 9, 2026

Plan of Operation. The licensee shall have and maintain a current, written definitive plan of operation for the facility....Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement was not met evidenced by: Based on record review and interviews, Licensee has not submitted an updated Plan of Operation that includes and addresses the physical plant changes made i.e., a former resident room (rm #3) is now the live-in staff room. This poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 26, 2026

Plan of correction: Administrator agreed to submit an updated plan of operation that addresses the physical plant changes and live-in staff accommodations in the home. * A civil penalty is assessed because it is a repeat violation.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Galarza conducted an unannounced case management visit. LPA met with unofficially appointed Andrew Escobar. The purpose of the visit was to follow-up on items addressed during the Noncompliance Conference (NCC) meeting held on September 17, 2025. License/Administrator Ana Duenas is on vacation for an extended period of time. *NOTE: Licensee did not notify CCL or submit LIC 308 "Designation of Facility Responsibility" delegating authority to appropriate staff during Licensee's absence. During the NCC meeting licensee agreed to: Hire an additional staff member within 30 days of (9/17/25) that will work as needed for oversight of record documentation, and other facility responsibilities. Status: Licensee Ana Duenas has not submitted to Community Care Licensing (CCL) proof that a new staff member/Administrator has been hired. Mr. Andrew Escobar was hired on 11/3/25 but has not been associated to the facility. Licensee did not notify CCL of staffing changes. Submit pending Type B plan of corrections within 30 days. Status: Licensee submitted plan of corrections. Licensee agreed to submit a written plan, update the Plan of Operation and facility sketch addressing live-in staff accommodations. If a permit for an additional dwelling unit (ADU) has been requested submit proof of documentation. Status: Licensee/Administrator has not submitted an updated plan of operation, facility sketch, and a written statement addressing live-in staff sleep accommodations. There are 2 live-in staff. One sleeps in the garage and the other sleeps in the living room. Andrew Escobar/Staff (S1's) file documents were obtained. Pursuant to Title 22, citations were issued. Exit interview was conducted and a copy of the report/appeal rights were issued to Andrew Escobar.the state’s words, verbatim · CDSS document, Nov 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Nov 19, 2025

Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: This requirement was not met evidenced by: Based on file review S1 was hired on 11/3/25, has criminal record clearance, but is not associated to the facility; which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Licensee shall ensure that all persons prior to working at the facility are associated through Guardian system. A civil penalty was assessed. Submit proof by tomorrow that S1 has been associated to the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Nov 19, 2025

Storage Space and Access. (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. Based on observation, there was a pair of unlocked scissors in resident (R1's) bedroom #1, unlocked knives and cleaning solutions in kitchen cabinets, and unlocked personal hygiene solutions stored in the living room, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Staff locked the kitchen knives cabinet and removed the scissors from bedroom #1. Proof of staff training and a written plan of correction shall be submitted by tomorrow.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Nov 25, 2025

Plan of Operation. The licensee shall have and maintain a current, written definitive plan of operation for the facility....Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement was not met evidenced by: Based record review, the Licensee did not submit the following items agreed upon during the 9/17/2025 NCC meeting: written plan, updated Plan of Operation and updated facility sketch addressing live-in staff accommodations. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Licensee shall submit a written plan of correction, updated Plan of Operation, updated facility sketch regarding live-in staff sleep arrangements and room occupancy.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a)(11) · Plan of correction due date: Nov 25, 2025

Personnel Records. The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 87411, Personnel Requirements - General. This requirement was not met evidenced by: Based on record review, staff (S1) was hired on 11/3/2025. Their file documents do not include a completed health screening/TB clearance. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Proof of staff (S1's) health screening/TB clearance shall be submitted by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Nov 25, 2025

Personal Accommodations and Services. Living accommodations and grounds shall be related to the facility's function. The facility .... provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement was not met evidenced by: Based on observation and interviews conducted, live-in staff (S2) is sleeping in the living room, and live-in staff (S3) sleeps in the garage. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Licensee/Administrator shall submit: 1. Written plan of correction addressing live-in staff accommodations and proof of plan of correction. *NOTE: The plan of operation and facility sketch do not state there will be live-in staff.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Nov 25, 2025

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met evidenced by: Based on observation, the facility interior and exterior physical plant is not clean and sanitary. All facility floors were dirty, kitchen counters and floors were dirty, and discarded furniture was observed in the backyard & garage. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Licensee shall submit picture proof evidence that the entire facility has been deep cleaned. Submit pictures of kitchen counters and floors, backyard patio area, and garage.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Nov 25, 2025

Administrator - Qualifications and Duties. All facilities shall have a qualified and currently certified administrator.... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section.... Based on observation and staff interviews, Licensee left on vacation out of the country on Nov. 11, 2025, and did not submit to CCL LIC 308 Designation of Facility Responsibility appointing new staff as a facility representative. This poses a potential l health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: Licensee shall submit a copy of LIC 308 Designation of Facility Responsibility.

Type of visit: Office

A Non-Compliance Conference meeting was held at the Monterey Park Adult and Senior Care Licensing Office. Regional Manager Tony Vasallo, Licensing Program Manager Lisa Hicks, and Licensing Program Analyst Noemi Galarza, and Licensing Program Analyst Kimberly Ramirez met with JAF Home Care Co.licensee Ana Duenas. The purpose of the meeting was to discuss numerous Type A and Type B citations issued within the last several years [April 2022 to present]. Concerns include inappropriate care and supervision, physical plant issues, record keeping, and medication management. Discussion: Twelve (13) Type A citations between April 2022 - to present. Twenty-eight (28) Type B citations between April 2022 - to present. Medication mismanagement of Dementia resident(s). Record keeping of staff file documents and resident documents that were missing and/or disorganized. No staff training for the years 2023- 2025. Physical Plant concerns cleanliness, repair, and safety. Plan of Operation changes i.e. staff living in the garage and in the resident room. Licensee was provided with a copy of the Non-Compliance Conference Summary, and at this time did not express interest in the CCLD Technical Support Program (TSP). Exit interview was conducted with Licensee Ana Duenas. A copy of this report and appeal rights were issued.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Gabriela Castro conducted an unannounced Case Management Visit-Plan of Correction (POC) on 09/15/2025. LPAs were greeted by Caregiver Antonio Santiago and explained the purpose of the visit. Case Management findings: On 09/06/2025, LPA Ramirez conducted an unannounced annual inspection and issued fourteen (14) deficiencies based on observations, interviews and records reviewed. As of 09/15/2025, ten (10) out of the fourteen (14) deficiencies issued have not been cleared, therefore, LPA Ramirez will issue Civil Penalties in the amount of $100 per day from 09/13/2025 through 09/15/2025, for the following uncorrected deficiencies: 1. 87309(a)- Type A 2. 87309(c)- Type A 3. 87303(f)(2) 4. 87412(a)(11) 5. 874119(c) 6. 87468(c)(2)(A) 7. 1569.695(c) SEE 809-C for continued report. 8.87458(a) 9. 87463(a) 10. 1569.605 Since the above deficiencies were not cleared by 09/12/2025 (POC due date), a civil penalty of $100 per deficiency per day will continue to be assessed until you have confirmed to the satisfaction of the Department that the deficiency has been corrected. See California Health and Safety Code Section 1548(b)(1), 1568.0822(b)(1), 1569.49(b)(1), 1596.99(b)(1), or 1597.58(b)(1). Please refer to Deficiencies & Plan of Correction (POCs) page 809-Dfrom annual visit on 09/06/2025 for plan of correction details and instructions. Civil penalties in the amount of $3,000.00 were assessed during today’s visit. Exit interview was conducted and a copy of this report, LIC 421FC and appeals rights was provided.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual inspection visit on 9/06/2025 and was greeted by Caregiver Antonio Santiago. Administrator Ana Duenas arrived shortly after. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be accessible to resident#1 (R1). Per R1's physician report, R1 may not have access to these items. Staff immediately removed these items upon LPA's observation. LPA Ramirez observed ZZZQuil supplement and Ultra Strength Sleep aid supplements on top of R1's nightstand. Per R1's physician report, R1 may not have access to these items. Staff immediately removed these items upon LPA's observation. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. All resident bedrooms contained the required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed non-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. LPA Ramirez observed 2 discarded hospital bed frames blocking passageway access to from bedroom#3. Staff are throwing disposing R1, R3 and R4's used lancets in the trash can. LPA Ramirez observed bathroom cabinet drawer in bedroom#3 to be in disrepair and exposing sharp screws. See 809-C for continued narrative Food Service: LPA Ramirez observed a sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: personal rights, and nondiscrimination notice. LPA Ramirez observed Complaint Poster (PUB 475) was not 20”x26” as required. LPA Ramirez observed facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Proof of quarterly Emergency drills was not provided upon request. LPA Ramirez observed an emergency food supply located in pantry. Residents with Special Needs: No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication cabinet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. Staffing: Administrator Certificate for Ana Duenas with an expiration date of 07/26/2027. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez did not observe the required CPR and First Aid training for three (3) out of the three (3) personnel record reviewed. S1 and S2 did not have the required annual training documented in their personnel file. LPA Ramirez did not observe S2’s health screening in their personnel file. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) residents over the age of 59 years old, of which five (5) may be non-ambulatory and one (1) bedridden. This facility may retain no more than three (3) hospice residents. There were three (3) residents on hospice during time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for six (6) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. Fourteen (14) violations were observed and cited during this annual inspection. Exit interview was conducted with Caregiver Antonio Santiago. A copy of this report, 809-D and appeals rights was provided via email.the state’s words, verbatim · CDSS document, Sep 6, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Administrator Ana Duenas. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. It consists of 4 resident rooms, 2 bathrooms, dining room/ living room, outdoor patio area, and attached garage. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: A hospice waiver for 3 residents has been approved. A fire clearance for 5 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4 only. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 8/26/2024. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. The facility has fully charged fire extinguishers. Water temperature readings did measured within the required 105 - 120 degrees Fahrenheit. Facility has a fire pull-alarm. Licensee has not kept Fire/Emergency Disaster drill logs in years. Staffing: A total of 3 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 7/26/2025. Staff have criminal background clearance and training. Three (3) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training. Administrator's 1st Aid/CPR training was not on file. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. No centrally stored medication records or medication administration records are in place. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. No residents are on modified diets. Incident Medical and Dental: Six (6) centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: Three (3) residents are receiving hospice services and zero (0) resident receive home health services. Two (2) residents have a Dementia diagnosis. Full bed rails for mobility assistance were observed in hospice resident's rooms. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Licensee Ana Duenas. A copy of the report and appeal rights was issued.the state’s words, verbatim · CDSS document, Jul 16, 2024