The Heavenly Home

Type of visit: Required - 1 Year

On March 23, 2026, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. Facility administrator (AD) Michelle Wulfestieg was at the facility to assist with the inspection. For this visit, there are three staff members on duty, all of which are background cleared and associated. The PUB475 ‘See Something, Say Something’ poster was observed to be located in the hallway near the front entrance. LPA observed that Michelle Wulfestieg has a valid Administrator certificate which expires on April 21, 2027. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be bedridden, and a hospice waiver for six. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of three bedridden residents, one non-ambulatory resident, and one ambulatory resident in care, and four of which are on hospice. The facility is a single story home. There are a total of five bedrooms, four of which are private resident bedrooms and one is a shared bedroom. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed that there are locked cabinets in the office for employee and resident records. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of two bathrooms, one is for residents and one is communal. Continued on LIC 809-C. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 119.3 and 119.4 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in a kitchen cabinet and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the living room. Fire extinguisher had a receipt with a purchase date of January 9, 2026. LPA observed the emergency disaster and evacuation plan, which is posted in the hallway. LPA observed the facility conducted their last emergency disaster drill on February 9, 2026. Facility had a valid liability certificate on file. Facility had back-up emergency food and water supplies, located in the garage. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a medication room near the front entrance, inaccessible to residents in care. Chemicals were observed to be locked in the garage and in the kitchen. LPA observed the door leading to the attached two car garage has an auditory exit alarm. The garage is used for storage, laundry, and has an art table for residents. Chemicals are stored in a locked cabinet in the garage. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards or obstructions. There are two self-closing gates in the backyard that can be opened in case of an emergency. No bodies of water were observed. During this visit, five resident files and four staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records. Three resident interviews were conducted. Based on today's observations, there are no deficiencies being cited per Title 22 of the California Code of Regulations. A Technical Violation was issued during today's visit. An exit interview was conducted with Michelle Wulfestieg. This report was reviewed with the administrator and a copy was provided at the end of the visit.the state’s words, verbatim · CDSS document, Mar 23, 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

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Vanessa Rosales followed by Caregiver Denise Hyde and explained the reason for the visit. Administrator (Admin) Michelle Wulfestieg arrived on premise to assist with the inspection. Administrator Wulfestieg has a valid administrator's certificate expiring on April 21, 2025. The facility is a single story structure and is licensed to operate for bedridden residents and has a hospice waiver for six residents. During the tour of the physical plant, LPA observed five resident bedrooms and two resident bathrooms. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 113.0 and 112.8 degrees Fahrenheit. All common areas were inspected including the attached two car garage. LPA observed sufficient emergency food and water. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen and garage. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. Both exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was mounted and purchased on January 14, 2025 per review of the purchase receipt. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. Emergency evacuation drills are conducted quarterly. Last known drill was conducted on January 14, 2025 per review of the log. The first aid kit contains all necessary elements. The facility land line number, (949) 770-7243, was tested and remains available. The liability insurance is valid expiring on July 1, 2025. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was available and posted in the correct size. LPA conducted a file review of all residents and one staff. No discrepancies noted. Medications were audited. Documentation errors observed. Interviews were conducted. The following items were addressed during the exit interview: to assemble the emergency supplies and amend the Emergency Disaster Plan (LIC610D), to ensure a record of each dose is maintained properly, and to maintaining a log when reconciling the medications. Based on the observations made during today's visit, no deficiencies are being cited. Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted Administrator Michelle Wulfestieg, and a copy of this report and the LIC9102s were provided at the end of the visit.the state’s words, verbatim · CDSS document, Mar 6, 2025

The state marks this report as 4 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 today's date, Licensing Program Analyst (LPA) Jessica Cho arrived unannounced to conduct the Required -1 Year Inspection. LPA stated the purpose of the visit to House Manager (HM) Kyshawna Owensby and Administrator (Admin) Michelle Wulfestieg and Licensee Shundra Moss arrived to assist with the inspection. LPA observed a total of 5 residents in care and three staff. LPA conducted a tour of indoor/outdoor area of the facility accompanied by HM Owensby and Admin Wulfestieg and the following were observed: This is a single story facility comprised of five resident bedrooms and two resident bathrooms, staff office, backyard, and a two car garage. LPA observed the backyard has patio cover for shading with outdoor furniture. The five resident bedrooms are spacious and can easily accommodate the residents' furnishings. Furniture for each resident bedrooms were inspected. The bathrooms were clean, faucets, and toilets were operational. The hot water temperature reading measured at 118.9 and 119.7 degrees Fahrenheit. There were sufficient supply of clean linens. LPA observed a 2-day supply of perishables and a 7-day supply of non-perishable food as required per regulations. The carbon monoxide and smoke detectors were tested and operational. LPA observed medications were centrally stored and secured. Administrator acknowledged to pay the upcoming licensing fee due March 30, 2024. LPA reviewed the five resident files and three staff files, interviewed one out of the five residents and three out of the three staff. LPA offered consultation for the following: to have the fire extinguisher serviced or purchased annually, to correctly dispense the medication corresponding with the calendar date, and to correctly document on the bubble pack when the medication refill started. Based on the observations made during today’s inspection, no deficiencies are being cited during today's visit. Two Technical Violations (TVs) will be issued. See the attached LIC9102s. An exit interview was conducted with Administrator Michelle Wulfestieg, Licensee Shundra Moss, House Manager Kyshawna Owensby, and a copy of this report including the TVs were issued at the end of the visit.the state’s words, verbatim · CDSS document, Jan 18, 2024