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Allegation investigated: Staff do not maintain facility free from hazards

Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with Jessica Guerrero, Administrator and explained the purpose of the visit. LPA requested a staff roster, staff schedule, and resident roster. LPA requested to see the housekkeeping cart and took photographs of the cart. LPA interviewed staff at 11:00am, 11:10am, 12:06pm, and 12:13pm. On the allegation: Staff do not maintain facility free from hazards. LPA took photographs of the housekeeping carts for mopping the floor the cart had 4 wet floor signs, gloves, cleaning products, cleaning rags, trash bag, mop and mop bucket. LPA observed the dining room being mopped, the area was ropped off, wet floor signs were present, no residents were present and no safety risks were observed. Continued 9099-C Unsubstantiated According to witness 1 (W1), W1 arrived at work and almost slipped on the wet floor. W1 stated there were not signs posted the floor was wet. W1 felt it could have been a safety risk to residents in care. W1 did not ask the staff to put up a sign. W1 did not inform supervisor or management of a safety concern. According to Administrator the staff mopping have signs on carts and should be putting them up when wet floors are present to help mitigate any safety hazards. The Administrator stated no staff on 07/07/2026 brought that to Administrators attention so it could have been dealt with and a sign posted. Administrator stated there were no reports of any slips or falls by any staff, residents or visitors that day. Administrator will hold a staff meeting to go over hazards, safety and requirements of staff reporting. Staff 1's (S1) interview revealed the housekeeping staff is under Maintenance Director and the housekeeping carts have signs to put up when mopping, S1 did not get any complaints from staff in regards to a sign not being posted in the area of the wet floor and said the staff mopping is suppose to post a sign. Staff 2's (S2) interview revealed S2 does housekeeping was working on 07/07/2026, S2 did mop on 07/07/2026 but can not recall if S2 had put out signs or not but S2 normally does. S2 said if a sign was not posted it was in error and S2 did not mean to cause a safety concern or had any intention of causing danger to anyone, S2 said if a sign was not posted no one said anything to S2 to about it and had someone said something S2 would have immediately put signs out, if signs were not already posted. Staff 3's (S3) interview revealed S3 does housekeeping, was working on 07/07/2026 and always puts out signs when mopping, at the beginning of where the mopping started and at the end of where the mopping stopped, S3 said the carts always has 3-4 signs on it to use and when S3 has trained other staff it has been a point to train staff to put out signs when the floor is wet. S3 never noticed anyone else mopping without putting a sign up and S3 said it is a safety concern and the staff that slipped should have notified a supervisor immediately so a sign could have been posted, if there was not already a sign posted, S3 said no one reported a fall or slip on wet floor to the staff on 07/07/2026, S3 said this should have been reported to avoid any hazards with residents, visitors, kids and families that visit the facility. Based on a lack of evidence and no residents, visitors or staff reported any hazards to the facility on 07/07/2026, therefore this allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Jul 9, 2026 · control 29-AS-20260708095923

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 10:10 am to conduct a 1 year annual visit to the facility above. LPA met with Administrator, Jessica Guerrero and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectant spray and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environmental Safety: The fire extinguisher were charged and tagged 06/04/2025. The facility has 3 wings: North, South and a West. This facility has 30 resident rooms, 22 bathrooms with Front desk, Sitting area, Lounge, Kitchen, Dining room, laundry room and fenced courtyard with fountain filled with river rock. The facility is completely fenced with a open gate for entry and another large gate for exiting, gates are kept open during business hours. The facility has dual smoke and carbon monoxide detectors which are hard wired and sprinkler system. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have secured grab bars and mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and stored in locked storage rooms and laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has a patio with furniture, pergola for shade and resident use. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 12/2026. The facility is approved for a capacity of 60. The fire clearance is approved for 60 Non-Ambulatory, which 10 may be bedridden in any room. Hospice wavier approved for 10. Staffing: The facility currently employes 23 staff, and 3 Administrators. Staff records are kept confidential. Five Staff files were reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and fingerprint clearance or exemptions. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed training files for 5 Staff. Annual training completed for 20 plus hours from 2024-2025 or 40 plus hours of initial training hired in 2025. All required subjects and topic are covered. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, Consent forms and Emergency/ID forms. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies in a storage room. Kitchen has hot tap faucets with safety signs posted. An adequate amount of emergency food and water is present. Incidental Medical/Dental Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call doctor and nurse practitioner that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications in the north medication cart, no labels were altered, no medications were expired and all medications were kept in their original containers. The facility has 3 wings and 3 medication carts kept locked. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. Codes are available for staff on all shifts to access full facility in an emergency. The facility had an annual Fire inspection in April 2025. Residents with Special Health Needs: The facility does accept dementia residents in care, all sharps, knives, cleaning products and items that can pose a hazard are locked in storage rooms. The facility currently has 2 residents on Oxygen and signs are posted. The facility has 6 residents on hospice services. The facility currently has 4 residents on home health services. Hospice and Home Health Plans are kept up to date and on file at the facility. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Nov 20, 2025

Type of visit: Prelicensing

At 11:00am on 12/13/2024, Licensing Program Analyst (LPA) De Leon conducted the Pre-Licensing visit. LPA met with Administrator, Raquel P. Flores and announced the purpose of the visit. This facility is a large 60 capacity 1 floor building, 3 wings North, South and West with a total of 30 resident rooms, 6 resident showers, 19 resident bathroom with toilets, 2 common area restrooms and 3 staff restroom. The fire clearance is approved for a maximum capacity of 60 residents with 10 that may be bedridden in any bedroom. The facility has two large driveway gates that remain unlocked during business hours. The facility has 2 courtyards with fencing all the way around and gates. The entrance of the facility has front receptionist office/desk, lounge area and restrooms. The North Wing has resident rooms, bathrooms, showers, supply closets, dining room/activity room, Activity office, and one other staff office, medication room with locked key coded door, LPA inspected random rooms 21, 23, 24, 25, 26, 28 and 30, all rooms have closets and exterior door exiting door alarms. The South Wing has residents rooms, bathrooms, and showers along with key coded locked storage closets, Staff break rooms and restrooms with lockers, LPA inspected rooms 1, 2, and 13 all rooms met requirements. The West Wing has Commercial Kitchen, cleaning closet, emergency supply of food and water, walk in refrigerator is set at 36.5 degrees and freezer is set at 0 degrees, resident rooms, bathrooms, showers, laundry room with storage for clean linens kept separately then soiled or dirty items and a staff restroom. The facility has video surveillance system and sketches marked with location of all cameras. The facility has emergency exiting lights, exiting door alarms, fire extinguishers charged and tagged 03/14/2024. The facility is set up to accommodate dementia residents, with locked storage rooms, locked medication room, locked cleaning closets, exiting alarms and a fenced courtyards. All cleaning, laundry products and anything that can pose a danger will be locked and inaccessible to residents in care. All rooms and bathrooms have operable pull cords for resident use. All restrooms have secured grab bars present. Facility is clean, safe and sanitary. Fire clearance and sketches match the facility as it is today. CONTINUED on LIC809-C LPA reviewed facility emergency evacuation plan and infection control which met regulation requirements. Administrator and LPA conducted a full review of the pre-licensing care tools and LPA conducted Component III with Licensee/Administrator on visit. "Pre-Licensing is complete and this facility has no deficiencies." Exit interview and copy of report provided to Licensee/Administrator.the state’s words, verbatim · CDSS document, Dec 13, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 60 Census (if any clients in care): none COMP II Participants: Steve Chou, Applicant Racquel Flores, Administrator Interview Method: Telephone interview On November 6, 2024 at 10:00 AM , Applicant and Administrator participated in COMP II. Identification of the Applicant and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB analyst confirmed Applicant and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with both Applicant and Administrator. Report sent via email and request to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Nov 6, 2024