Terra Lago Assisted Living

Type of visit: Case Management - Deficiencies

This Case management– Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Abdoulaye Zerbo for the purpose of issuing citations for deficiencies observed during the visit on 04-24-26. LPA met with Caregiver Maricela Rodriguez and explained purpose of the visit. During the visit, LPA reviewed records and observed S1 not associated to the facility. Based on record review and interviews, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809-D. An exit interview was conducted, and a copy of this report, the LIC 421BG and the appeal rights were provided to facility representative, Maricela Rodriguez.the state’s words, verbatim · CDSS document, Apr 24, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1522(b)(1)(D) · Plan of correction due date: Apr 24, 2026

1522 Fingerprints and criminal records; exemptions; criminal record clearances (b) (1) In addition to the applicant, this section is applicable to criminal record clearances and exemptions for the following persons: (D) Any staff person, volunteer, or employee who has contact with the clients. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by allowing Caregiver, Jonathan Ontiveros to work in the facility for approximately two weeks without a current criminal record clearance or exemption, which posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 24, 2026

Plan of correction: Once the Adminstrator was informed, she associated Jonathan and stated that he no longer works at the facility.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Armando Perez conducted an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPAs were greeted by Abid Hussain, notified of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 4 bedrooms and 3 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair.LPAs observed a reclining sofa being used as a bed for the resident. A physician's order from the resident's doctor was provided allowing patient to sleep in recliner The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were hard wired together and operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with and expiration date of 12/31/2025. LPAs observed the hot water temperature to meet requirements at 106.7°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of March 8th, 2025. Continued on LIC809-C..... Record Review and Resident/Staff Files: LPAs reviewed files for four staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five residents' files were reviewed and contained all required documentation. LPA's observed Staff, resident files, first aid kit, PPE's were store in closet room and emergency food and water stored in the garage. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked located in the living room area. LPAs reviewed medications for five residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-2-2024, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Abid Hussain LPAs took lunch from 12:30PM to 01:05PMthe state’s words, verbatim · CDSS document, Oct 10, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/31/2023, Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Staff, Saif Ali Choudry, who was informed of the purpose of the visit. LPA spoke with Administrator Sahar Choudry during the visit, At the time of the visit there was (1) staff and (5) resident present. The facility is a one story home with attached garage. No firearms or pools are present at the facility. The home has (4) bedrooms and (3) bathrooms. The residents served are elderly adults ages 60 years and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: Infection Control: The LPA observed hand washing stations with hand hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a plan to train staff on infection control guidelines. Physical Plant: Physical plant was observed to be clean and in good repair. The indoor and outdoor areas were observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The smoke detector and carbon monoxide were operational, and the hot water temperature was recorded at 106.5F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Record Review and Resident/Staff Files: LPA reviewed staff files and training. All staff have criminal clearance. During the visit the one (2) staff at the facility had CPR training which was expired.The administrator re-certification was verified as being submitted, however the Administrator and Assistant- administrator do not have documented training for review during the time of the visit. Deficiency was cited for staff records and plan of correction was created with administrator. Resident files were reviewed all of which posessed required documents. Health Related Services/ Incidental Medical Services: All client medication was locked in kitchen pantry. LPA reviewed resident medications, all of which were accounted for. One medication, M1 for Resident 1 (R1) did not have a current doctors order at the facility. The administrator was able to provide documentation by the end of the visit. A technical advisory note was documented for all resident medication records to be updated. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. Technical noted was documented for facility to update this to the current department requirements. The last fire drill was conducted April 2023. Deficiency was cited and administrator stated they would conduct Fire Drill by the end of the business day 10/31/23. An exit interview was conducted where a copy of this report along with deficiency, technical notes and appeal rights were reviewed and provided to Staff, Saif Ali Choudry.the state’s words, verbatim · CDSS document, Oct 31, 2023